How Perceived Pain Influence Sleep and Mood More Than The Reverse: A Novel, Exploratory Study with Patients Awaiting Total Hip Arthroplasty

Abstract

Objectives: Attributions about how comorbid symptoms worsen or improve each other are central cognitive components of chronic pain that are shown to facilitate or impede the recovery process. Still, these attributions have been poorly illuminated in chronic pain patients. The present study explored perceptions of how sleep, pain, and mood influence each other in patients awaiting total hip arthroplasty (THA).Design and Methods: In this cross-sectional study, 291 patients (mean age 67.8, 65.3% female) rated 12 statements about how much a given symptom (pain, sleep, mood) changed when another symptom (pain, sleep, mood) worsened or improved on a response scale ranging from much worse (-2) via no change (0) to much better (2). Sleep (Bergen Insomnia Scale), pain (McGill Pain Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale) were assessed as background variables.Results: Of the patients in the study, 56% reported symptoms indicating insomnia. Anxiety and depression were indicated in 16 and 10%, respectively. Over 80% rated their pain as horrible/unbearable and reported that pain occurred always/daily. When experiencing increased pain, a majority perceived that sleep (90%) and mood (70%) worsened, whilst experiencing reduced pain improved sleep and mood in 50%. Poor sleep increased pain and worsened mood in 45 and 60% of the patients, respectively. Better sleep was perceived to reduce pain and improve mood in 50%. Worsened mood increased pain (46%) and worsened sleep (52%). Improved mood decreased pain and improved sleep in 25 and 35%, respectively.Discussion: In this study, a novel approach was used to investigate perceptions of reciprocal relationships between symptoms. We found that THA patients perceived interrelationships between pain, sleep and mood. These perceived interrelations were stronger when symptoms worsened than when symptoms improved. They also held stronger beliefs about the effect of pain on sleep and mood, than the effect of sleep and mood on pain. Attributions are central in illness perception and ultimately affect illness behavior. For patients who perceive symptoms to interrelate, the door has already been opened to utilize these attributions in treatments aiming to disrupt vicious cycles, hence supporting the use of multimodal treatments.

Effects of Sleep Fragmentation and Induced Mood on Pain Tolerance and Pain Sensitivity in Young Healthy Adults

“…An explanation for the lack of effects of induced emotion on pain may be that emotions have a weaker effect on pain than on sleep. This assumption is in line with a recent study of how pain patients attribute the reciprocal impact of pain, sleep and mood ( Blågestad et al, 2016 , p. 1689). However, the strength of manipulations of the two independent variables is difficult to compare, and another explanation of the lack of effects of induced emotions, may be that larger differences in mood than those obtained in the present study, need to be present in order to detect differences between conditions in terms of nociception.…”

Insomnia Really Hurts: Effect of a Bad Night's Sleep on Pain Increases With Insomnia Severity

“…To our knowledge, the perceived acute sleep–pain relationship has only been investigated within a specific clinical sample in a smaller-scale study ( 42 ). Our results about the asymmetric perceived acute sleep–pain relationship agree with that study, thereby demonstrating generalizability.…”

“…The pain assessment module of the NSR also contains 4 items about the perceived acute relationship between sleep and pain, similar to those used in a previous study ( 42 ). The perceived acute effect of sleep on pain is addressed by 2 items, “If I sleep worse/better than usual on one night, the next day the chance of feeling pain is …” and the answer options are “much smaller,” “smaller,” “somewhat smaller,” “as usual,” “somewhat bigger,” “bigger,” and “much bigger” (coded as −3, −2, −1, 0, 1, 2, and 3, respectively).…”

Cerebrospinal Fluid Findings of 36 Adult Patients with Autism Spectrum Disorder

“…All of the included participants were informed about the lumbar puncture and gave their written informed consent. The CSF analyses were performed in the CSF laboratory at the Department of Neurology ( ) as described in previous studies [ 40 , 41 , 42 ]. Routine CSF analysis included the determination of white blood cell (WBC) count, total protein concentration, albumin quotient (AQ), immunoglobulin G (IgG) index, and oligoclonal bands (OCBs).…”