Experiencing Painful Osteoarthritis: What Have We Learned From Listening?

Gillian A Hawker


Curr Opin Rheumatol. 2009;21(5):507-512. 

In This Article

The Relationship between Sleep and Pain in Osteoarthritis

The negative impact of pain on sleep is considered one of the most distressing features of the osteoarthritis pain experience.[15••] In other painful conditions,[20,21] pain has been associated with delayed sleep onset, bedtime anxiety, and changes in sleep architecture. The relationship is circular, such that a night of poor sleep is followed by a day of increased pain[21–23] and a day with intense pain is followed by sleep of poor quality.[24,25] These findings have prompted researchers to evaluate this relationship more closely in osteoarthritis. Allen et al.[26] examined the association between self-reported hip or knee pain and subjective sleep quality among participants in the Johnston County Osteoarthritis Project, a community-based cohort of adults with/without symptomatic hip and knee osteoarthritis. Self-reported sleep problems (any problem, insomnia, and insufficient sleep) were more common among those with painful hip/knee osteoarthritis even after adjusting for depressed mood and self-rated health. Turk et al.[27] reviewed 10 placebo-controlled trials that systematically evaluated the impact of opioid analgesics on pain and sleep in chronic painful osteoarthritis. Although the studies were generally of short duration and varied in the measures used to evaluate sleep, the authors concluded that patients who received opioid analgesics experienced both reduced pain and improved sleep quality (reduced awakenings from pain and increased sleep duration). These findings support the need for improved pain control in osteoarthritis to improve sleep quality and underscore the importance of evaluating sleep in the assessment of patients with painful osteoarthritis.


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