PainRelief.com Interview with: MARK HAMER, PhD PROFESSOR OF SPORT AND EXERCISE MEDICINE DIVISION OF SURGERY & INTERVENTIONAL SCIENCE UNIVERSITY COLLEGE LONDON
PainRelief.com: Can you provide more insight into how much more beneficial moderate to vigorous activities are compared to light activities or standing, in terms of measurable health outcomes?
Response: Our study suggests that the best activity that you can do for your heart is moderate-vigorous activity, followed by a trio of common daily activities: lighter activity, standing and sleeping, with sedentary behaviour being the most harmful. There was a very large and strong association between spending more time in moderate to vigorous activities and better heart health outcomes (outcomes included: BMI, waist circumference, HDL cholesterol, HDL: total cholesterol ratio, triglycerides and blood glucose levels).
For example, replacing 30 min of sedentary behaviour with moderate to vigorous activity was associated with 0.63kg/m2 lower BMI (or –2.4cm lower waist circumference). If an individual were to replace the sedentary time with 30 minutes of light activity instead, we would expect to see a ~0.5 kg/m2 lower BMI. And if an individual replaced their sedentary time with 30 min of either standing or sleep, we would expect to see a ~0.4kg/m2 decrease. These difference in benefits was much larger when considering cholesterol and triglyceride outcomes.
It was notable that heart health benefits are likely to be observed after replacing just a few minutes of sedentary/sitting time with moderate to vigorous activity. However, to achieve comparable benefits with standing or light activity, it could require 1-3 hours of replacement depending on the outcome (slightly less for measures of obesity such as BMI, much more for cardiometabolic blood biomarkers like cholesterol or triglycerides).
PainRelief.com Interview with: Shiqian Shen, M.D. Assistant Anesthetist –Anesthesia & Crit. Care, Massachusetts General Hospital Associate Professor of Anaesthesia –Harvard Medical School Physician Investigator (Cl) –Anesthesia, Critical Care and Pain Medicine, Mass General Research Institute
PainRelief.com: What is the background for this study? Would you describe the function of NADA?
Response: Both sleep disorders and chronic pain are very prevalent among adults. For example, about one third of U.S. adults report some level of sleep disturbance. Both common life experience and medial research strongly suggest that sleep deprivation leads to heightened pain experience/perception. However, the mechanisms of this link are not entirely clear. Hence we decide to study this important question.
NADA, N-arachidonoyl dopamine was first discovered to be an agonist for the Cannabinoid Receptor 1 and it was found in the brain of animals. It belongs to the endocannabinoid family. Additionally, NADA also belongs to the endovanilloid family. Administration of NADA to rodents produces a wide variety of behavioral changes, including behaviors mimicking the physiological paradigms association with cannabinoids. However, its physiological function is not well characterized.
PainRelief.com Interview with: Joerg Steier PhD Professor of Respiratory and Sleep Medicine Guy’s & St. Thomas NHS Foundation Trust King’s College London
PainRelief.com: What is the background for this study? Where is the TENS unit applied?
Response: Patients with obstructive sleep apnoea hold their breath at night, which fragments their sleep and leads to daytime symptoms like excessive daytime sleepiness. Keeping the tone of the neuromuscular structures, particularly the hypoglossal nerve and the genioglossus muscle, elevated at night using electrical current has become an established treatment over the last decade.
Hypoglossal nerve stimulation, however, is using an implantable device, is costly, and requires surgical intervention. The novelty in the current study is that using a transcutaneous electrical neurostimulator (TENS) that is placed underneath the chin in the submental area can achieve significant improvements sleep apnoea severity and associated symptoms as well.
PainRelief.com Interview with: Dr Renato Vellucci Contract Professor University of Florence Pain and Palliative care Clinic University Hospital of Careggi Florence, Italy
PainRelief.com: What is the background for this study? What are the main findings?
Response: Chronic low back pain (CLBP) is the most prevalent chronic pain (CP) condition and the leading global cause of years lived with disability. According to the axiom pain as a biopsychosocial issue, mood and sleep disturbances represent key issues. However, the impact of different analgesic therapies on quality of life (QoL) and functional recovery has been poorly assessed to date. Focusing on combination of chronic pain and sleep, they both perform a mutual reinforcement.
Pain disorganizes the sleep architecture, and disturbed and unrefreshed sleep increases spontaneous pain and lowers pain thresholds. Sleep disorders may augment stress levels, thus making it difficult for patients to perform simple tasks impairing their cognitive ability. Poor sleep may predict the growth and intensification of pain over time, with increased insomnia symptoms being both a predictor and an indicator of worse pain outcomes and physical functioning status over time. Epidemiology of chronic pain unequivocally demonstrates the role of sleep quality in the development of chronic pain.
Notwithstanding this strong two-way relationship between chronic pain and sleep, little knowledge is available about the neurochemical determinants of this interplay and therapeutical strategies to break this vicious circle. Fifty percent of people with chronic low back pain have sleeping disturbances, with an 18-fold increase in insomnia versus healthy people. A recent study investigated the relationship between sleep disturbances and back pain and found that it is two sided with sleep disturbance being associated with risk of back pain whilst back pain can also lead to sleep disturbances. Thus, it can be hypothesized that, by reducing pain and physical dysfunction, sleep quality could be improved, thus enriching the QoL of people with CLBP.
Similarly, improvements in sleep after cognitive behavioral therapy in patients with chronic pain due to osteoarthritis were associated with reduced pain. Earlier evidence suggested that tapentadol prolonged-release treatment ameliorate in parallel QoL and sleep quality in a greater proportion of patients compared to that of patients following oxycodone/naloxone prolonged- release treatment (50% versus 37.7%). Other tapentadol studies conducted in a real-life context documented, along with effective pain control, similar improvements in mental and physical health and suggested beneficial effects in terms of less night awakenings and greater percentages of patients reporting restful sleep.
PainRelief.com Interview with: Eric J. Roseen, DC, MSc Assistant Professsor, Department of Family Medicine Boston University School of Medicine and Boston Medical Center
PainRelief.com: What is the
background for this study? What are the
Response: Sleep disturbance and insomnia are common among people with chronic low back pain (cLBP). Previous research showed that 59% of people with cLBP experience poor sleep quality and 53% are diagnosed with insomnia disorder. Medication for both sleep and back pain can have serious side effects, and risk of opioid-related overdose and death increases with use of sleep medications. Given the serious risks of combining pain and sleep medications, we evaluated the use of nonpharmacologic approaches to manage sleep quality in adults with chronic low back pain.
Our randomized controlled trial included 320 adults with chronic low back pain from predominantly low-income racially diverse neighborhoods of Boston. At the beginning of the study, over 90 percent of participants with cLBP reported poor sleep quality. Participants were randomly assigned one of three different therapies for cLBP: physical therapy (PT), weekly yoga, or reading educational materials. Our previous research showed that yoga and PT are similarly effective for lowering pain and improving physical function, and reduced the need for pain medication. In this study, results for sleep improvements were compared over a 12-week intervention period and after 1 year of follow-up.
PainRelief.com Interview with: Dr. Daniel Whibley PhD Department of Physical Medicine and Rehabilitation University of Michigan, Ann Arbor, Michigan Epidemiology Group, School of Medicine, Medical Sciences and Nutrition University of Aberdeen, Scotland, UK
PainRelief.com: What is the
background for this study? What are the
Response: Older adults with osteoarthritis commonly report symptoms of pain, fatigue and poor sleep quality. Previous research has investigated how this symptoms are cross-sectionally and longitudinally associated with each other. However, no previous studies have investigated how the quality of a night’s sleep impacts on the next day’s course of pain and fatigue in this clinical population.
We found that poor sleep quality was associated with greater pain intensity and fatigue on awakening when compared to a good night’s sleep and that, over the course of the day, the effects were sustained. Although a night of better quality sleep was associated with less pain and fatigue on awakening, these symptoms worsened more rapidly throughout the day, such that as the day progressed the effect of the previous night’s sleep became less and less important.
Dawn C. Buse PhD Clinical Professor of Neurology Albert Einstein College of Medicine New York City
PainRelief.com: What is the
background for this study?
Response: Sleep is essential in the regulation of a wide range of homeostatic
functions. Dysregulation of sleep process may be triggers for
migraine attacks and increase the risk of migraine disease
chronification. Migraine is comorbid with a range of medical,
neurologic, and psychiatric comorbidities that may exacerbate the disease,
complicate treatment, and reduce health-related quality of
life. These comorbidities include sleep disorders such as sleep
apnea, insomnia, circadian rhythm (i.e., sleep-wake) disorders, and sleep
The Chronic Migraine Epidemiology and Outcomes
(CaMEO) Study is a longitudinal study that used a series of web-based surveys
over 15 months to assess migraine symptoms, burden and patterns of healthcare
utilization among people in the US population. Validated
questionnaires were used to assess many comorbidities. Migraine can
be classified based on the number of headache days per month into episodic
migraine (<15 headache days/month) and chronic migraine (≥15 headache
In this cross-sectional analysis of data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, we assessed sleep apnea and poor sleep quality in a US population based sample of 12,810 people with migraine. Respondents were stratified by episodic (11,699) and chronic (1,111) migraine and by body mass index (BMI).
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