The Effect of Neuropathic Pain on Sleep Quality in Patients with Axial Spondyloarthritis Neuropathic Pain and Sleep in Axial Spondyloarthritis
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Abstract
Objective: This study aims to determine whether neuropathic pain (NP) presence affects sleep quality in patients with axial spondyloarthritis (AxSpA).
Materials and Methods: Demographic data of the patients were documented. The patient's NP was evaluated with painDETECT questionnaire. Pittsburgh Sleep Quality Index (PSQI), Ankylosing Spondylitis Quality of Life (AsQoL), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), and visual analog scale (VAS) were used to evaluate sleep quality, quality of life (QoL), pain severity and disease activity, respectively.
Results: Among the 108 patients who participated in the researh, 51 were female and 57 were male. NP was found in 41.7% of them. 65.7% Of all patients had a sleep disorder. AxSpA patients with NP had a statistically significant higher VAS-activity, VAS-night, and VAS-rest scores (p<0.001, p<0.001, p=0.002, respectively). They also had higher ASQoL scores and higher disease activity. (p=0.008, p=0.012, respectively).
Although impaired sleep was detected in 71.1% of AxSpA patients with NP, it was present in 61.9% of AxSpA patients without NP, and we didn’t find a statistically significant difference (p=0.32). Total painDETECT scores were correlated with PSQI ASQoL, and VAS scores (p< 0.001). But there was no correlation with ASDAS-CRP scores (p=0.57).
Conclusion: A large majority of AxSpA patients have a sleep problem, independent of the presence of NP. Not only targeting the inflammatory pain but also targeting NP and sleep disorder together in the follow-up of patients with AxSpA will improve QoL.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2022-10-21
Published 2022-10-22
References
Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med. 2016 Jun 30;374(26):2563–74. DOI: https://doi.org/10.1056/NEJMra1406182
Sieper J, Poddubnyy D. Axial spondyloarthritis. The Lancet. 2017 Jul 1;390(10089):73–84. DOI: https://doi.org/10.1016/S0140-6736(16)31591-4
Mathieu S, Couderc M, Pereira B, Dubost J-J, Malochet-Guinamand S, Tournadre A, et al. Prevalence of migraine and neuropathic pain in rheumatic diseases. J Clin Med. 2020;9(6):1890. DOI: https://doi.org/10.3390/jcm9061890
Wu Q, Inman RD, Davis KD. Neuropathic pain in ankylosing spondylitis: a psychophysics and brain imaging study. Arthritis Rheum. 2013;65(6):1494–503. DOI: https://doi.org/10.1002/art.37920
Bidad K, Gracey E, Hemington KS, Mapplebeck JCS, Davis KD, Inman RD. Pain in ankylosing spondylitis: a neuro-immune collaboration. Nat Rev Rheumatol. 2017 Jul;13(7):410–20. DOI: https://doi.org/10.1038/nrrheum.2017.92
Treede R-D, Jensen T, Campbell J, Cruccu G, Dostrovsky J, Griffin J, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70(18):1630–5. DOI: https://doi.org/10.1212/01.wnl.0000282763.29778.59
Van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: A systematic review of epidemiological studies. Pain. 2014;155(4):654–62. DOI: https://doi.org/10.1016/j.pain.2013.11.013
Batmaz I, Sarıyıldız MA, Dilek B, Bez Y, Karakoç M, Çevik R. Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatol Int. 2013;33(4):1039–45. DOI: https://doi.org/10.1007/s00296-012-2513-2
Li Y, Zhang S, Zhu J, Du X, Huang F. Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study. Arthritis Res Ther. 2012;14(5):1–10. DOI: https://doi.org/10.1186/ar4054
Melikoglu MA, Celik A. Does neuropathic pain affect the quality of sleep? Eurasian J Med. 2017;49(1):40. DOI: https://doi.org/10.5152/eurasianjmed.2017.16261
Smith BH, Hébert HL, Veluchamy A. Neuropathic pain in the community: prevalence, impact, and risk factors. Pain. 2020;161:S127–37. DOI: https://doi.org/10.1097/j.pain.0000000000001824
Sieper J, van der Heijde D, Landewe R, Brandt J, Burgos-Vagas R, Collantes-Estevez E, et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis. 2009;68(6):784–8. DOI: https://doi.org/10.1136/ard.2008.101501
Freynhagen R, Baron R, Gockel U, Tölle TR. Pain DETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22(10):1911–20. DOI: https://doi.org/10.1185/030079906X132488
Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. DOI: https://doi.org/10.1016/0165-1781(89)90047-4
Doward L, Spoorenberg A, Cook S, Whalley D, Helliwell P, Kay L, et al. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis. 2003;62(1):20–6. DOI: https://doi.org/10.1136/ard.62.1.20
Van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, et al. ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68(12):1811–8. DOI: https://doi.org/10.1136/ard.2008.100826
Scott J, Huskisson E. Graphic representation of pain. pain. 1976;2(2):175–84. DOI: https://doi.org/10.1016/0304-3959(76)90113-5
Külcü DG, Batibay S, Öztürk G, Mesci N. The association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study. Turk J Med Sci. 2018;48(2):257–65. DOI: https://doi.org/10.3906/sag-1707-147
Gok K, Cengiz G, Erol K, Ozgocmen S. Neuropathic Pain Component in Axial Spondyloarthritis and the Influence on Disease Burden. JCR J Clin Rheumatol. 2018 Sep;24(6):324–7. DOI: https://doi.org/10.1097/RHU.0000000000000711
Zhou L, Li T, Wu X, Lu H, Lin L, Ye L, et al. Assessment of Neuropathic Pain in Ankylosing Spondylitis: Prevalence and Characteristics. Pain Ther. 2021;10(2):1467–79. DOI: https://doi.org/10.1007/s40122-021-00310-8
Rifbjerg-Madsen S, Christensen AW, Christensen R, Hetland ML, Bliddal H, Kristensen LE, et al. Pain and pain mechanisms in patients with inflammatory arthritis: A Danish nationwide cross-sectional DANBIO registry survey. PLOS ONE. 2017 Jul 7;12(7):e0180014. DOI: https://doi.org/10.1371/journal.pone.0180014
Garip Y, Filiz E, KILIÇARSLAN A, Bodur H. Prevalence of neuropathic pain in rheumatic disorders: association with disease activity, functional status and quality of life. Arch Rheumatol. 2015;30(3):231–7. DOI: https://doi.org/10.5606/ArchRheumatol.2015.5295
Freynhagen R, Tölle TR, Gockel U, Baron R. The painDETECT project – far more than a screening tool on neuropathic pain. Curr Med Res Opin. 2016 Jun 2;32(6):1033–57. DOI: https://doi.org/10.1185/03007995.2016.1157460
Aydin E, Bayraktar K, Turan Y, Omurlu I, Tastaban E, Sendur OF. Sleep quality in patients with ankylosing spondylitis. Rev Bras Reumatol. 2015;55:340–5. DOI: https://doi.org/10.1016/j.rbre.2014.12.007
Abdulaziez O, Asaad T. Sleep problems in ankylosing spondylitis: polysomnographic pattern and disease related variables. Egypt Rheumatol. 2012;34(2):59–65. DOI: https://doi.org/10.1016/j.ejr.2012.02.001
Wadeley A, Clarke E, Leverment S, Sengupta R. Sleep in ankylosing spondylitis and non-radiographic axial spondyloarthritis: associations with disease activity, gender and mood. Clin Rheumatol. 2018;37(4):1045–52. DOI: https://doi.org/10.1007/s10067-018-3984-7
Deodhar A, Gensler LS, Magrey M, Walsh JA, Winseck A, Grant D, et al. Assessing physical activity and sleep in axial spondyloarthritis: measuring the gap. Rheumatol Ther. 2019;6(4):487–501. DOI: https://doi.org/10.1007/s40744-019-00176-5
Leverment S, Clarke E, Wadeley A, Sengupta R. Prevalence and factors associated with disturbed sleep in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review. Rheumatol Int. 2017;37(2):257–71. DOI: https://doi.org/10.1007/s00296-016-3589-x
Haack M, Simpson N, Sethna N, Kaur S, Mullington J. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology. 2020;45(1):205–16. DOI: https://doi.org/10.1038/s41386-019-0439-z
van Middendorp H, Evers AW. The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment. Best Pract Res Clin Rheumatol. 2016;30(5):932–45. DOI: https://doi.org/10.1016/j.berh.2016.10.012
Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Res Clin Pract. 2000;47(2):123–8. DOI: https://doi.org/10.1016/S0168-8227(99)00112-6
Tymms K, Butcher BE, Sletten TL, Smith T, O’Sullivan C, Littlejohn G, et al. Prevalence of sleep disturbance and the association between poor disease control in people with ankylosing spondylitis within the Australian clinical setting (ASLEEP study): a real-world observational study using the OPAL dataset. Clin Rheumatol. 2021;1–10. DOI: https://doi.org/10.1007/s10067-021-05953-8
Macfarlane GJ, Rotariu O, Jones GT, Pathan E, Dean LE. Determining factors related to poor quality of life in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS). Ann Rheum Dis. 2020;79(2):202–8. DOI: https://doi.org/10.1136/annrheumdis-2019-216143