PainRelief.com Interview with: Carrie Cuttler, Ph.D. Associate Professor The Health & Cognition (THC) Lab Department of Psychology Washington State University
PainRelief.com: What is the background for this study?
Response: We know that one of the top 5 reasons cannabis users report using cannabis is for sleep disturbances, but we don’t know very much about the types of products they prefer to use for sleep or their perceptions of its effects and side effects relative to more conventional sleep aids (e.g., benzodiazepines, antihistamines, melatonin).
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.
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