Association Between Pharmacotherapy and Sleep Quality in Patients with Chronic Orofacial and Chronic Body Pain: A Cross-Sectional Study

Abstract

Paula Furlan Bavia,1 Shehryar Khawaja,2,3 María F Hernández-Nuño de la Rosa,4 Lisa A Tseng,5 David Alexander Keith6 1Private Practice Boca Raton Prosthodontics (Practice Limited to Orofacial Pain), Boca Raton, FL, USA; 2Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan; 3Craniofacial Pain Center, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 4Department of Oral and Maxillofacial Surgery, Tufts University School of Dental Medicine, Boston, MA, USA; 5Pain Medicine, Kaiser Permanente, Redwood City, CA, USA; 6Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USACorrespondence: Paula Furlan Bavia, Email [email protected]: Sleep impairment is associated with many chronic pain disorders. While there is an association between chronic pain and sleep disturbances, little is known about the influence of pharmacotherapy for chronic pain conditions, particularly chronic opioid therapy, on sleep. This study aimed to 1) compare the sleep quality (SQ) in patients with two different pain conditions-chronic body pain and chronic orofacial pain; 2) assess the correlation of SQ and pain intensity; and 3) evaluate the association between pharmacotherapy and SQ.Patients and Methods: The Pittsburgh Sleep Quality Index (PSQI) was used to measure the SQ in subjects with 1) chronic body pain (n = 100) and 2) chronic orofacial pain (n = 100). The visual analogue scale was applied for pain intensity rating. All subjects were adults recruited at Massachusetts General Hospital, United States. The subjects’ demographic data, pain intensity, diagnosis and concurrent use of medications were extracted from their electronic medical records (EMR). Statistical analyses were performed using T-test and Pearson correlation coefficient.Results: Among 200 subjects (mean age 51.01 ± 15.52 years), 141 (70.5%) were females. PSQI and pain intensity were statistically significantly different between the two groups (p < 0.05 and p < 0.0001, respectively) and higher in subjects with chronic body pain. There was a positive correlation between PSQI and pain intensity (chronic orofacial pain r = 0.3535, p = 0.0004; chronic body pain: r = 0.2247, p < 0.026). PSQI was higher in chronic orofacial pain subjects utilizing opioids and benzodiazepines (PSQI = 15.25).Conclusion: Chronic pain impairs SQ, which is noticeably worse in subjects with body pain conditions. In addition, pain intensity was correlated with poorer SQ, which in turn was linked to the concomitant use of opioid and benzodiazepine therapy in chronic orofacial pain.Keywords: sleep quality, chronic pain, pain intensity, pharmacotherapy, opioids, benzodiazepines

Keywords

• sleep quality
• chronic pain
• pain intensity
• pharmacotherapy
• opioids
• benzodiazepines