【疼痛专题】进入三级疼痛护理的疼痛患者的睡眠问题:疼痛相关焦虑、药物使用、自我报告的疾病和睡眠障碍的作用

2022
06/23

+
分享
评论
Luffy麻醉频道
A-
A+

进入三级医疗机构的大部分疼痛患者都会反复出现睡眠问题。

  Sleep problems in pain patients entering tertiary pain care: the role of pain-related anxiety, medication use, self-reported diseases, and sleep disorders  进入三级疼痛护理的疼痛患者的睡眠问题:疼痛相关焦虑、药物使用、自我报告的疾病和睡眠障碍的作用   

60171655943577821

1       Introduction  

Chronic pain and sleep problems frequently co-occur. Pain itself disturbs sleep, but other factors may also contribute to sleep problems in pain patients.The first aim of this study was to investigate how patients with sleep problems differ from normally sleeping pain patients regarding a diverse set of factors known or suspected to influence.The second aim is further evaluate the role of painrelated anxiety components in disordered sleeping.

慢性疼痛和睡眠问题经常同时发生。疼痛本身会干扰睡眠,但其他因素也可能导致疼痛患者的睡眠问题。本研究的第一个目的是调查睡眠问题患者与正常睡眠疼痛患者在已知或怀疑影响的多种因素方面有何不同;第二个目标,为了进一步评估疼痛相关焦虑成分在睡眠障碍中的作用。

2       Methods  

This was a cross-sectional study with a cohort comprising 473 patients entering tertiary pain management and participating in the multicentre (3 multidisciplinary pain clinics and 3 facial pain clinics) KROKIETA study. The cohort comprises chronic pain patients with mixed pain aetiologies, such as low back pain, neuropathic pain, fibromyalgia, or complex regional pain syndrome, who had been referred to tertiary pain care by their physicians after inadequate treatment response in primary care. Patients having active cancer were not recruited to the study. KROKIETA collected a broad range of data, including sociodemographic, health, psychological, lifestyle, and biochemical variables.

这是一项横断面研究,队列包括 473 名进入三级疼痛管理并参与多中心KROKIETA 研究的患者。该队列包括具有混合疼痛病因的慢性疼痛患者,例如腰痛、神经性疼痛、纤维肌痛或复杂的区域疼痛综合征,患有活动性癌症的患者排除在外。KROKIETA 收集了广泛的数据,包括社会人口学、健康、心理、生活方式和生化变量。

3     Results  

This cross-sectional study of 473 patients (69.9% female, mean age 47 years) entering tertiary pain management compared normally sleeping pain patients with those having recurring sleep problems to determine the relationship between pain and sleep. Groups were compared for pain and pain aetiology, pain-related anxiety, childhood adversities, use of sleep and pain medications, self-reported diseases, and sleep disorders. Furthermore, the association of pain-related anxiety (cognitive anxiety, escape/avoidance, fear, and physiological anxiety) with more disturbing sleep problems was investigated in the whole cohort.

这项横断面研究对 473 名进入三级疼痛管理的患者(69.9% 女性,平均年龄 47 岁)进行了比较,比较了正常睡眠疼痛患者和反复出现睡眠问题的患者,以确定疼痛与睡眠之间的关系。比较各组的疼痛和疼痛病因、疼痛相关的焦虑、童年逆境、睡眠和止痛药的使用、自我报告的疾病和睡眠障碍。此外,在整个队列中调查了与疼痛相关的焦虑(认知焦虑、逃避/回避、恐惧和生理焦虑)与更令人不安的睡眠问题的关联。

  3.1 Demographics and pain 基础信息和疼痛     

49211655943578387

睡眠正常者和反复出现睡眠问题的人在年龄、性别或受教育年限方面没有差异。与睡眠正常的患者相比,有睡眠问题的患者工作或学习的频率更低(38.1% 对 59.0%,P=0.004),独居的频率更高(28.1% 对 14.8%,P=0.04)。有睡眠问题的患者平均疼痛强度高出 2.08 个点(95% CI:1.48-2.67;P,0.001),疼痛部位的中位数更多(4.0 vs 2.0,P,0.001)和疼痛持续时间> 2 年(78.1% 对 61.0%;P 5 0.01)比正常睡眠的患者更多。

  3.2 Childhood adversities 童年逆境     

Those having sleep problems and those sleeping normally did not differ in median numbers of childhood adversities experienced or incidences of individual adversities.In the whole cohort, the most common adversities experienced were parents’ divorce (29.0%), bullying at school (28.8%), and own serious illness (12.7%). 75.3% of all patients in the cohort reported at least one childhood adversity.

有睡眠问题的人和正常睡觉的人在经历的童年逆境中位数或个别逆境的发生率方面没有差异.在整个队列中,最常见的逆境是父母离婚(29.0%)、学校欺凌(28.8%)和自己的重病(12.7%)。队列中所有患者中有 75.3% 报告了至少一次童年逆境。

  3.3 Medication use 药物使用     

15521655943578744

27.8% 的有睡眠问题的患者定期使用处方安眠药(每周 3 晚或更多晚),而只有 3.3% 的正常睡眠患者报告了这一情况(P 0.001).唑吡坦和褪黑激素是睡眠问题患者中最常用的影响睡眠的药物(两者均被 12.6% 的患者使用)。

  3.4. Self-reported diseases and sleep disorders 自我报告的疾病和睡眠障碍     

86151655943579012

有睡眠问题的人心绞痛(6.5% vs 0.0%;P=0.04)、哮喘(19.6% vs 1.7%;P=0.001)、非RA关节疾病(32.3% vs 18.3%;P=5)的发病率更高0.04)、腰背问题(55.1% 对 23.3%;P 0.001)和抑郁症(31.6% 对 5.0%;P 0.001)比睡眠正常的人(表 3)

3.5 Regression analyses with pain-related anxiety 疼痛相关焦虑的回归分析 

79221655943579207

该完整的模型,包括疼痛强度、疼痛区域的数量、疼痛持续时间> 2 年,生理焦虑作为预测因子,在统计上显着预测因变量超过截距模型 x2(4)=111.278, P =< 0.001;Nagelkerke R2 =0.265(表 4)。持续超过 2 年的疼痛在模型中并不显着.当疼痛相关认知焦虑、恐惧或逃避/回避被添加到模型中,生理焦虑仍然显着,而添加的变量不显着。

4       Conclusions   * 1 

A high proportion of pain patients entering tertiary care suffer from recurring sleep problems. The results of this study reinforce the belief that sleep problems in pain patients are likely to be highly multifactorial. Alongside previously established factors, such as pain intensity and depression, this study draws attention to physiological anxiety reactions, co-occurring diseases (such as angina pectoris and asthma), restless legs symptoms, and the use of sleep and pain medications. The careful assessment of all these factors and planning treatment accordingly is the key for addressing sleep problems in pain patients. Acknowledging these factors as early as possible in primary care may even halt the development of sleep problems for some patients.  

进入三级医疗机构的大部分疼痛患者都会反复出现睡眠问题。这项研究的结果强化了这样一种信念,即疼痛患者的睡眠问题可能是高度多因素的。除了先前确定的因素,如疼痛强度和抑郁症,本研究还关注生理性焦虑反应、同时发生的疾病(如心绞痛和哮喘)、不宁腿症状以及睡眠和止痛药的使用。仔细评估所有这些因素并相应地计划治疗是解决疼痛患者睡眠问题的关键。在初级保健中尽早承认这些因素甚至可以阻止一些患者出现睡眠问题。

笔记/差劲先森。

排版/叮当丸子麻

本文由“健康号”用户上传、授权发布,以上内容(含文字、图片、视频)不代表健康界立场。“健康号”系信息发布平台,仅提供信息存储服务,如有转载、侵权等任何问题,请联系健康界(jkh@hmkx.cn)处理。
关键词:
睡眠,疼痛,pain,患者,问题

人点赞

收藏

人收藏

打赏

打赏

我有话说

0条评论

0/500

评论字数超出限制

表情
评论

为你推荐

推荐课程


社群

精彩视频

您的申请提交成功

确定 取消
剩余5
×

打赏金额

认可我就打赏我~

1元 5元 10元 20元 50元 其它

打赏

打赏作者

认可我就打赏我~

×

扫描二维码

立即打赏给Ta吧!

温馨提示:仅支持微信支付!