Research Article
The relationship between insomnia and acute postoperative pain: a case-control study on laparoscopic cholecystectomy patients
Abstract
Aims: Psychological factors play a significant role in predicting postoperative pain. However, the impact of insomnia on acute postoperative pain is little known. The aim of this study was to investigate the relationship between insomnia and acute postoperative pain.
Methods: We performed a case-control study in patients undergoing elective laparoscopic cholecystectomy. Patients with an Insomnia Severity Index (ISI) score >14 were allocated to an insomnia group (n=35) and those with an ISI score <7 to a control group (n=35). All patients were asked to rate their current level of pain on a numeric rating scale (NRS) at 1, 2, 4, 8, 12, and 18 hours postoperatively.
Results: There was no between-group differences in age, gender, body mass index, American Society of Anesthesiologists score, or operating time. The patients in the insomnia group had higher NRS scores and requested significantly greater amounts of tramadol (269.4±33 mg vs. 235.0±36 mg; p<0.001) and rescue analgesia (paracetamol; 1.06±0.8 g vs. 0.40±0.7 g; p<0.001) postoperatively than did the controls. Analysis of covariance revealed a significant interaction between insomnia and the preoperative experience of pain (F=6.62; p=0.013) and significant impact of insomnia on the mean NRS score (F=15.47; p<0.001).
Conclusion: Patients who experienced preoperative insomnia and underwent elective cholecystectomy have a reduced threshold for postoperative pain, which increases the need for analgesics.
References
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- Botti M, Bucknall T, Manias E. The problem of postoperative pain: issues for future research. Int J Nurs Pract. 2004;10(6):257-263. doi:10.1111/j.1440-172x.2004.00487.x
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition:DSM-5 (American Psychiatric Association, 2013)
- American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd Edition (American Academy of Sleep Medicine, 2014)
- Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC. Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry. 2006;60(12):1364-1371. doi:10.1016/j.biopsych.2006.05.039.
- Sarsour K, Morin CM, Foley K, Kalsekar A, Walsh JK. Association of insomnia severity and comorbid medical and psychiatric disorders in a health plan-based sample: Insomnia severity and comorbidities. Sleep Med. 2010;11(1):69-74. doi:10.1016/j.sleep.2009.02.008
- Tang NK. Insomnia co-occurring with chronic pain: clinical features, interaction, assessments and possible interventions. Rev Pain. 2008;2(1):2-7. doi:10.1177/204946370800200102
- Ohayon MM. Relationship between chronic painful physical condition and insomnia. J Psychiatr Res. 2005;39(2):151-159. doi:10.1016/j.jpsychires.2004.07.001
- McBeth J, Wilkie R, Bedson J, Chew-Graham C, Lacey RJ. Sleep disturbance and chronic widespread pain. Curr Rheumatol Rep. 2015;17(1):469. doi:10.1007/s11926-014-0469-9
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- Mork PJ, Nilsen TI. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012;64(1):281-284. doi:10.1002/art.33346
- Nitter AK, Pripp AH, Forseth KØ. Are sleep problems and non-specific health complaints risk factors for chronic pain? A prospective population-based study with 17 year follow-up. Scand J Pain. 2012;3(4):210-217. doi:10.1016/j.sjpain.2012.04.001
- Odegård SS, Sand T, Engstrøm M, Stovner LJ, Zwart JA, Hagen K. The long-term effect of insomnia on primary headaches: a prospective population-based cohort study (HUNT-2 and HUNT-3). Headache. 2011;51(4):570-580. doi:10.1111/j.1526-4610.2011.01859.x
- Brennan TJ. Pathophysiology of postoperative pain. Pain. 2011;152(3 Suppl):S33-S40. doi:10.1016/j.pain.2010.11.005
- Sobol-Kwapinska M, Bąbel P, Plotek W, Stelcer B. Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis. Eur J Pain. 2016;20(10):1573-1586. doi:10.1002/ejp.886
- Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307. doi:10.1016/s1389-9457(00)00065-4
- Boysan M, Güleç M, Beşiroğlu L, Kalafat T. Psychometric properties of the Insomnia Severity Index in Turkish sample. Anadolu Psikiyatri Derg. 2010;11:248-52. https://www.researchgate.net/publication/49290217
- Erden V, Abitağaoğlu S, Güler C, Doğan Z, Kırgezen Ş, Abut Y. Insomnia may increase anesthetic requirement. J Clin Anesth. 2016;34:367-372. doi:10.1016/j.jclinane.2016.05.020
- Kundermann B, Spernal J, Huber MT, Krieg JC, Lautenbacher S. Sleep deprivation affects thermal pain thresholds but not somatosensory thresholds in healthy volunteers. Psychosom Med. 2004;66(6):932-937. doi:10.1097/01.psy.0000145912.24553.c0
- Nascimento DC, Andersen ML, Hipólide DC, Nobrega JN, Tufik S. Pain hypersensitivity induced by paradoxical sleep deprivation is not due to altered binding to brain mu-opioid receptors. Behav Brain Res. 2007;178(2):216-220. doi:10.1016/j.bbr.2006.12.016
- Roehrs T, Hyde M, Blaisdell B, Greenwald M, Roth T. Sleep loss and REM sleep loss are hyperalgesic. Sleep. 2006;29(2):145-151. doi:10.1093/sleep/29.2.145
- Schey R, Dickman R, Parthasarathy S, et al. Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease. Gastroenterology. 2007;133(6):1787-1795. doi:10.1053/j.gastro. 2007.09.039
- Onen SH, Alloui A, Gross A, Eschallier A, Dubray C. The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. J Sleep Res. 2001;10(1):35-42. doi:10.1046/j.1365-2869.2001.00240.x
- Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30(4):494-505. doi:10.1093/sleep/30.4.494
- Hambrecht-Wiedbusch VS, Gabel M, Liu LJ, Imperial JP, Colmenero AV, Vanini G. Preemptive caffeine administration blocks the increase in postoperative pain caused by previous sleep loss in the rat: a potential role for preoptic adenosine A2A receptors in sleep-pain interactions. Sleep. 2017;40(9):10.1093/sleep/zsx116. doi:10.1093/sleep/zsx116
- Haack M, Mullington JM. Sustained sleep restriction reduces emotional and physical well-being. Pain. 2005;119(1-3):56-64. doi:10.1016/j.pain.2005.09.011
- Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007
- Aili K, Nyman T, Svartengren M, Hillert L. Sleep as a predictive factor for the onset and resolution of multi-site pain: a 5-year prospective study. Eur J Pain. 2015;19(3):341-349. doi:10.1002/ejp.552
- Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15. doi:10.1016/j.pain.2010.09.030
- Campbell CM, Buenaver LF, Finan P, et al. Sleep, pain catastrophizing, and central sensitization in knee osteoarthritis patients with and without insomnia. Arthritis Care Res (Hoboken). 2015;67(10):1387-1396. doi:10.1002/acr.22609
- Curatolo M, Müller M, Ashraf A, et al. Pain hypersensitivity and spinal nociceptive hypersensitivity in chronic pain: prevalence and associated factors. Pain. 2015;156(11):2373-2382. doi:10.1097/j.pain.0000000000000289
- Finan PH, Smith MT. The comorbidity of insomnia, chronic pain, and depression: dopamine as a putative mechanism. Sleep Med Rev. 2013;17(3):173-183. doi:10.1016/j.smrv.2012.03.003
- Farooqui SM, Brock JW, Zhou J. Changes in monoamines and their metabolite concentrations in REM sleep-deprived rat forebrain nuclei. Pharmacol Biochem Behav. 1996;54(2):385-391. doi:10.1016/0091-3057(95)02072-1
- Blanco-Centurion CA, Salin-Pascual RJ. Extracellular serotonin levels in the medullary reticular formation during normal sleep and after REM sleep deprivation. Brain Res. 2001;923(1-2):128-136. doi:10.1016/s0006-8993(01)03209-7
- Haack M, Scott-Sutherland J, Santangelo G, Simpson NS, Sethna N, Mullington JM. Pain sensitivity and modulation in primary insomnia. Eur J Pain. 2012;16(4):522-533. doi:10.1016/j.ejpain.2011.07.007
- Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30(4):494-505. doi:10.1093/sleep/30.4.494
- Denis D, French CC, Gregory AM. A systematic review of variables associated with sleep paralysis. Sleep Med Rev. 2018;38:141-157. doi:10.1016/j.smrv.2017.05.005
- Nijs J, Loggia ML, Polli A, et al. Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients?. Expert Opin Ther Targets. 2017;21(8):817-826. doi:10.1080/14728222.2017.1353603.
- Miller GE, Chen E, Zhou ES. If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull. 2007;133(1):25-45. doi:10.1037/0033-2909.133.1.25
- Giese M, Unternaehrer E, Brand S, Calabrese P, Holsboer-Trachsler E, Eckert A. The interplay of stress and sleep impacts BDNF level. PLoS One. 2013;8(10):e76050. doi:10.1371/journal.pone.0076050
- Léger D, Poursain B, Neubauer D, Uchiyama M. An international survey of sleeping problems in the general population. Curr Med Res Opin. 2008;24(1):307-317. doi:10.1185/030079907x253771
- Morin CM, Leblanc M, Ivers H, et al. Monthly fluctuations of insomnia symptoms in a population-based sample. Sleep. 2014;37(2):319-326. doi:10.5665/sleep.3406
- Sommer M, de Rijke JM, van Kleef M, et al. Predictors of acute postoperative pain after elective surgery. Clin J Pain. 2010;26(2):87-94. doi:10.1097/AJP.0b013e3181b43d68
- De Cosmo G, Congedo E, Lai C, Primieri P, Dottarelli A, Aceto P. Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia. Clin J Pain. 2008;24(5):399-405. doi:10.1097/AJP.0b013e3181671a08
- Sangesland A, Støren C, Vaegter HB. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review. Scand J Pain. 2017;15:44-52. doi:10.1016/j.sjpain.2016.12.002
- Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487-504.
Year 2023,
Volume: 5 Issue: 4, 323 - 328, 27.10.2023
Abstract
References
- Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139-144. doi:10.1016/S0140-6736(08)60878-8
- van Boekel RLM, Warlé MC, Nielen RGC, et al. Relationship between postoperative pain and overall 30-day complications in a broad surgical population: an observational study. Ann Surg. 2019;269(5):856-865. doi:10.1097/SLA.0000000000002583
- Botti M, Bucknall T, Manias E. The problem of postoperative pain: issues for future research. Int J Nurs Pract. 2004;10(6):257-263. doi:10.1111/j.1440-172x.2004.00487.x
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition:DSM-5 (American Psychiatric Association, 2013)
- American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd Edition (American Academy of Sleep Medicine, 2014)
- Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC. Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry. 2006;60(12):1364-1371. doi:10.1016/j.biopsych.2006.05.039.
- Sarsour K, Morin CM, Foley K, Kalsekar A, Walsh JK. Association of insomnia severity and comorbid medical and psychiatric disorders in a health plan-based sample: Insomnia severity and comorbidities. Sleep Med. 2010;11(1):69-74. doi:10.1016/j.sleep.2009.02.008
- Tang NK. Insomnia co-occurring with chronic pain: clinical features, interaction, assessments and possible interventions. Rev Pain. 2008;2(1):2-7. doi:10.1177/204946370800200102
- Ohayon MM. Relationship between chronic painful physical condition and insomnia. J Psychiatr Res. 2005;39(2):151-159. doi:10.1016/j.jpsychires.2004.07.001
- McBeth J, Wilkie R, Bedson J, Chew-Graham C, Lacey RJ. Sleep disturbance and chronic widespread pain. Curr Rheumatol Rep. 2015;17(1):469. doi:10.1007/s11926-014-0469-9
- Davies KA, Macfarlane GJ, Nicholl BI, et al. Restorative sleep predicts the resolution of chronic widespread pain: results from the EPIFUND study. Rheumatology (Oxford). 2008;47(12):1809-1813. doi:10.1093/rheumatology/ken389
- Mork PJ, Nilsen TI. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012;64(1):281-284. doi:10.1002/art.33346
- Nitter AK, Pripp AH, Forseth KØ. Are sleep problems and non-specific health complaints risk factors for chronic pain? A prospective population-based study with 17 year follow-up. Scand J Pain. 2012;3(4):210-217. doi:10.1016/j.sjpain.2012.04.001
- Odegård SS, Sand T, Engstrøm M, Stovner LJ, Zwart JA, Hagen K. The long-term effect of insomnia on primary headaches: a prospective population-based cohort study (HUNT-2 and HUNT-3). Headache. 2011;51(4):570-580. doi:10.1111/j.1526-4610.2011.01859.x
- Brennan TJ. Pathophysiology of postoperative pain. Pain. 2011;152(3 Suppl):S33-S40. doi:10.1016/j.pain.2010.11.005
- Sobol-Kwapinska M, Bąbel P, Plotek W, Stelcer B. Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis. Eur J Pain. 2016;20(10):1573-1586. doi:10.1002/ejp.886
- Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307. doi:10.1016/s1389-9457(00)00065-4
- Boysan M, Güleç M, Beşiroğlu L, Kalafat T. Psychometric properties of the Insomnia Severity Index in Turkish sample. Anadolu Psikiyatri Derg. 2010;11:248-52. https://www.researchgate.net/publication/49290217
- Erden V, Abitağaoğlu S, Güler C, Doğan Z, Kırgezen Ş, Abut Y. Insomnia may increase anesthetic requirement. J Clin Anesth. 2016;34:367-372. doi:10.1016/j.jclinane.2016.05.020
- Kundermann B, Spernal J, Huber MT, Krieg JC, Lautenbacher S. Sleep deprivation affects thermal pain thresholds but not somatosensory thresholds in healthy volunteers. Psychosom Med. 2004;66(6):932-937. doi:10.1097/01.psy.0000145912.24553.c0
- Nascimento DC, Andersen ML, Hipólide DC, Nobrega JN, Tufik S. Pain hypersensitivity induced by paradoxical sleep deprivation is not due to altered binding to brain mu-opioid receptors. Behav Brain Res. 2007;178(2):216-220. doi:10.1016/j.bbr.2006.12.016
- Roehrs T, Hyde M, Blaisdell B, Greenwald M, Roth T. Sleep loss and REM sleep loss are hyperalgesic. Sleep. 2006;29(2):145-151. doi:10.1093/sleep/29.2.145
- Schey R, Dickman R, Parthasarathy S, et al. Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease. Gastroenterology. 2007;133(6):1787-1795. doi:10.1053/j.gastro. 2007.09.039
- Onen SH, Alloui A, Gross A, Eschallier A, Dubray C. The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. J Sleep Res. 2001;10(1):35-42. doi:10.1046/j.1365-2869.2001.00240.x
- Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30(4):494-505. doi:10.1093/sleep/30.4.494
- Hambrecht-Wiedbusch VS, Gabel M, Liu LJ, Imperial JP, Colmenero AV, Vanini G. Preemptive caffeine administration blocks the increase in postoperative pain caused by previous sleep loss in the rat: a potential role for preoptic adenosine A2A receptors in sleep-pain interactions. Sleep. 2017;40(9):10.1093/sleep/zsx116. doi:10.1093/sleep/zsx116
- Haack M, Mullington JM. Sustained sleep restriction reduces emotional and physical well-being. Pain. 2005;119(1-3):56-64. doi:10.1016/j.pain.2005.09.011
- Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007
- Aili K, Nyman T, Svartengren M, Hillert L. Sleep as a predictive factor for the onset and resolution of multi-site pain: a 5-year prospective study. Eur J Pain. 2015;19(3):341-349. doi:10.1002/ejp.552
- Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15. doi:10.1016/j.pain.2010.09.030
- Campbell CM, Buenaver LF, Finan P, et al. Sleep, pain catastrophizing, and central sensitization in knee osteoarthritis patients with and without insomnia. Arthritis Care Res (Hoboken). 2015;67(10):1387-1396. doi:10.1002/acr.22609
- Curatolo M, Müller M, Ashraf A, et al. Pain hypersensitivity and spinal nociceptive hypersensitivity in chronic pain: prevalence and associated factors. Pain. 2015;156(11):2373-2382. doi:10.1097/j.pain.0000000000000289
- Finan PH, Smith MT. The comorbidity of insomnia, chronic pain, and depression: dopamine as a putative mechanism. Sleep Med Rev. 2013;17(3):173-183. doi:10.1016/j.smrv.2012.03.003
- Farooqui SM, Brock JW, Zhou J. Changes in monoamines and their metabolite concentrations in REM sleep-deprived rat forebrain nuclei. Pharmacol Biochem Behav. 1996;54(2):385-391. doi:10.1016/0091-3057(95)02072-1
- Blanco-Centurion CA, Salin-Pascual RJ. Extracellular serotonin levels in the medullary reticular formation during normal sleep and after REM sleep deprivation. Brain Res. 2001;923(1-2):128-136. doi:10.1016/s0006-8993(01)03209-7
- Haack M, Scott-Sutherland J, Santangelo G, Simpson NS, Sethna N, Mullington JM. Pain sensitivity and modulation in primary insomnia. Eur J Pain. 2012;16(4):522-533. doi:10.1016/j.ejpain.2011.07.007
- Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30(4):494-505. doi:10.1093/sleep/30.4.494
- Denis D, French CC, Gregory AM. A systematic review of variables associated with sleep paralysis. Sleep Med Rev. 2018;38:141-157. doi:10.1016/j.smrv.2017.05.005
- Nijs J, Loggia ML, Polli A, et al. Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients?. Expert Opin Ther Targets. 2017;21(8):817-826. doi:10.1080/14728222.2017.1353603.
- Miller GE, Chen E, Zhou ES. If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull. 2007;133(1):25-45. doi:10.1037/0033-2909.133.1.25
- Giese M, Unternaehrer E, Brand S, Calabrese P, Holsboer-Trachsler E, Eckert A. The interplay of stress and sleep impacts BDNF level. PLoS One. 2013;8(10):e76050. doi:10.1371/journal.pone.0076050
- Léger D, Poursain B, Neubauer D, Uchiyama M. An international survey of sleeping problems in the general population. Curr Med Res Opin. 2008;24(1):307-317. doi:10.1185/030079907x253771
- Morin CM, Leblanc M, Ivers H, et al. Monthly fluctuations of insomnia symptoms in a population-based sample. Sleep. 2014;37(2):319-326. doi:10.5665/sleep.3406
- Sommer M, de Rijke JM, van Kleef M, et al. Predictors of acute postoperative pain after elective surgery. Clin J Pain. 2010;26(2):87-94. doi:10.1097/AJP.0b013e3181b43d68
- De Cosmo G, Congedo E, Lai C, Primieri P, Dottarelli A, Aceto P. Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia. Clin J Pain. 2008;24(5):399-405. doi:10.1097/AJP.0b013e3181671a08
- Sangesland A, Støren C, Vaegter HB. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review. Scand J Pain. 2017;15:44-52. doi:10.1016/j.sjpain.2016.12.002
- Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487-504.
There are 47 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology, Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Early Pub Date | October 26, 2023 |
| Publication Date | October 27, 2023 |
| Published in Issue | Year 2023 Volume: 5 Issue: 4 |
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