Sleep as a marker in the effective management of chronic osteoarthritis pain with opioid analgesics.
OBJECTIVE
Sleep disturbances frequently accompany chronic pain from osteoarthritis (OA), and their effective management may reflect successful treatment of chronic pain. The objective of this article is to provide a rationale for using improvement in sleep as a marker for effective management of chronic OA pain with opioid analgesics. For this purpose, available evidence evaluating the relationship between successful management of chronic pain with opioids and improvements in sleep in patients with OA is reviewed.


METHODS
We conducted a comprehensive PubMed search to identify studies that systematically measured the impact of opioid treatment on pain and sleep parameters in the context of chronic pain from OA. Our search criteria included publication in a recognized peer-reviewed journal, randomized placebo-controlled design, and assessment of both pain intensity and sleep as outcomes.


RESULTS
In each of the 10 placebo-controlled studies identified, concurrent improvements in pain intensity and measured sleep disturbances were observed in patients receiving the long-acting opioid analgesics under study. Improved overall sleep quality, reduced awakenings from pain, and increased duration of sleep were among the favorable changes observed in patients with OA treated with long-acting opioids.


CONCLUSIONS
Current evidence suggests that various long-acting opioid analgesics simultaneously achieve pain control and improve sleep. However, the complex interaction between reduced pain and improved sleep requires further study.
Turk
Dennis C
DC
John and Emma Bonica Professor of Anesthesiology and Pain Research, Department of Anesthesiology, University of Washington, Seattle, Washington 98195, USA. turkdc@u.washington.edu
Cohen
Mitchell J M
MJ
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D015415:Biomarkers; D002908:Chronic Disease; D006801:Humans; D010003:Osteoarthritis / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D039781:PubMed; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012890:Sleep / Q000187:drug effects*; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*
D000701:Analgesics, Opioid; D015415:Biomarkers