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Balance Between Sleep and Exercise May be Key to Help Osteoarthritis Patients Manage Pain

Noah Fromson wrote . . . . . . . . .

It may shoot through the hands while typing or flare in the knees when getting out of the car. Wherever the pain, over 32 million Americans living with osteoarthritis experience it.

To reduce that pain, patients living with the degenerative joint disease are often told to exercise.

It sounds simple.

But people with osteoarthritis may experience pain when they start to move more, which can be a deterrent to taking up, or sticking with, an exercise program.

“Pain during movement is an important reason why this population isn’t more active, and we need to identify ways we can help to change this,” said Daniel Whibley, Ph.D., research assistant professor of physical medicine and rehabilitation at Michigan Medicine. “Otherwise, they may end up in a loop of pain and inactivity that we know can lead to disability later down the line.”

A growing body of research suggests that maintaining good sleep health – specifically good quality sleep for an appropriate duration – in patients with osteoarthritis may reduce pain. There is also strong evidence supporting links between sleep and being physically active.

“If you’re sleeping well, you’re more likely to be able to move more the next day or stick with a planned exercise program,” Whibley said. “And those who are physically active during the day are more likely to get a good night’s sleep.”

Whibley’s team looked to develop a new intervention that brought together insights from previous research that supports these relationships.

“There are many different physical activity or exercise programs for people with osteoarthritis, but they spend relatively little time on sleep,” he said. “Conversely, some researchers have started to investigate the effectiveness of cognitive behavioral therapy, the process of rooting out problematic thoughts and changing cognitive patterns, for insomnia as a way of reducing osteoarthritis-related pain.”

What hasn’t been investigated is whether intensively and simultaneously targeting both sleep and physical activity – and the optimal balance between them – results in better pain outcomes. Alongside a team of researchers, Whibley introduced the concept of a hybrid sleep-exercise program to two focus groups composed of people living with osteoarthritis-related pain and sleep disturbances.

The sleep improvement component involves an automated program called Sleepio, which delivers cognitive-behavioral therapy for insomnia over the internet, as well as components focused on sleep education and behavioral modifications to sleep routines. In tandem with the six-week Sleepio course, users complete an exercise program with remote weekly support from a program coach.

During the focus groups, researchers explained the outline plan for the hybrid program and encouraged discussion between participants about how best to adapt design and delivery plans. These discussions informed the development of prototype materials which were then shared and refined with the same study participants at a second round of focus groups held a month later.

The findings, published in the British Journal of Pain and supported through Versus Arthritis and the Dan Barry Research Program, reveal that motivational language, personal accountability and accessible educational materials are important features to include in a successful program for sleep and exercise for osteoarthritis-related pain.

“The participants wanted to be encouraged to stick to the sleep and exercise components of the program using terms void of negative associations that made it seem like punishment,” Whibley said. “They also wanted to share records of activity with health care professionals without feeling like they have no power in the dynamic.”

These features, however, also present parallel challenges.

Previous negative interactions with health care providers – like feeling patronized or underestimated – and being asked to excessively record sleep and daily physical activity may cause people using the program to feel disinterested or discouraged, said Anna Kratz, Ph.D., a co-investigator on the study and associate professor of physical medicine and rehabilitation at Michigan Medicine.

“Developing an understanding of what factors may present barriers to engaging with the program was a primary reason to conduct the focus groups,” Kratz said. “In response to our findings, we were then able to create intervention materials that would be more attractive to potential users, including a workbook that supports adaptation of intervention content for the individual using it – they can set their own activity or sleep goals and keep track of their progress.”

A test of the program’s feasibility is currently underway with a small group of people living with osteoarthritis. Once complete, the team will conduct a full trial. The results, Whibley hopes, will provide more insight into the relationship between sleep, physical activity and exercise, and how their balance can impact pain in this population.

“People living with osteoarthritis want to improve their sleep, physical activity and exercise behavior and reduce their pain – all of these are valued outcomes,” Whibley said. “I’m not saying this new program will be a magic bullet for everyone, but I think the hybrid approach holds great potential for the future of osteoarthritis-related pain management.”


Source: University of Michigan

Chronic Pain Treatment Should Include Psychological Interventions

Pain is the body’s way of alerting the brain to injury and disease. Without a robust pain response, physical trauma could go unnoticed and untreated. Some people, however, experience chronic pain that lasts long after an injury has healed or has no easily identifiable cause.

Unfortunately, treating chronic pain with over-the-counter and prescription medication has its own health risks, including adverse side effects and addiction. In the latest issue of Psychological Science in the Public Interest (PSPI), a team of researchers explores how psychological interventions can be part of a comprehensive plan to manage chronic pain while reducing the need for surgeries and potentially dangerous medications.

“There are several effective nonmedical treatments for chronic pain, and psychological treatments emerge among the strongest of these,” said Mary Driscoll, a researcher at Yale University and first author on the issue’s main article. “People who engage in psychological treatments can expect to experience meaningful reductions in pain itself as well as improvements in physical functioning and emotional well-being.”

The current state of care

In many cases, the causes of chronic pain are unknown, and the use of traditional medical interventions, such as pain medication and surgery, may give little to no relief—or make the condition worse. People with chronic pain often report frustrations with health care systems and health insurance, which tend to be dismissive or unsuccessful in addressing their complaints.

Psychological treatment may reduce the need for medications, surgeries, and other invasive treatments that can be costly, ineffective, and even dangerous. And research suggests that the effects of psychological treatment can be maintained for a lifetime.

“People with pain should feel empowered to select the psychological treatment that is most appealing,” said Driscoll. “Once they do, finding a psychotherapist who can provide this care and with whom they can establish a meaningful connection will be a key factor in obtaining benefit.”

Psychological treatments

Research has shown that psychological factors can play a role in the onset, severity, and duration of chronic pain. For those reasons, several psychological interventions have been shown to be effective in treating chronic pain.

In the article, Driscoll and her colleagues describe the interventions that have been most widely studied by the pain community, including:

  • Supportive psychotherapy, which emphasizes unconditional acceptance and empathic understanding
  • Relaxation training, or the use of breathing, muscle relaxation, and visual imagery to counteract the body’s stress response
  • Biofeedback, which involves monitoring patients’ physiological responses to stress and pain (e.g., increased heart rate, muscle tension) and teaching them how to down-regulate these responses
  • Hypnosis by a trained clinician, which may induce changes in pain processing, expectations, or perception and incorporates relaxation training
  • Cognitive-behavioral therapy, in which patients learn to reframe maladaptive thoughts about pain that cause distress; change unhelpful behaviors, such as isolation and inactivity; and develop helpful behavioral coping strategies (e.g., relaxation)
  • Mindfulness-based interventions, which help to disentangle physical pain from emotional pain via increased awareness of the body, the breath, and activity
  • Psychologically informed physical therapy, which integrates physical therapy and cognitive-behavioral therapy

The PSPI report also addresses topics such as integrated pain care, or the blending of medical, psychological, and social aspects of health care; the future of pain treatment; and improving the availability and integration of pain-management strategies.


Source: Association for Psychological Science