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      Relationship between cold pressor pain-sensitivity and sleep quality in opioid-dependent males on methadone treatment

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          Abstract

          Aim. Poor sleep quality due to pain has been reported among opioid-dependent male patients on methadone maintenance therapy (MMT) but objective pain data are lacking. This study aimed to investigate the rate of pain-sensitivity using cold pressor test (CPT) and the relationship between pain-sensitivity and sleep quality in this population.

          Methods. A total of 168 male participants were included into the study. Objective pain-tolerance was evaluated at 0 h and at 24 h after the first CPT. Malay version of the Pittsburgh Sleep Quality Index (PSQI) and the subjective opiate withdrawal scale (SOWS) questionnaires were administered to evaluate the quality of sleep and withdrawal symptoms, respectively.

          Results. The mean age of study participants was 37.22 (SD 6.20) years old. Mean daily methadone dose was 76.64 (SD 37.63) mg/day, mean global PSQI score was 5.47 (SD 2.74) and mean averaged SOWS score was 5.43 (SD 6.91). The averaged pain-tolerance time ranged from 7 to 300 s with a mean time of 32.16 (SE 2.72) s, slightly below the cut-off score of 37.53 s. More specifically, 78.6% ( n = 132) of participants were identified as pain-sensitive (averaged pain-tolerance time ≤37.53 s), and 36 (21.4%) participants were pain-tolerant (averaged pain-tolerance time >37.53 s). The pain-sensitive group reported poorer sleep quality with mean (SD) PSQI of 5.78 (2.80) compared with the pain-tolerant group with mean (SD) PSQI of 4.31 (2.18) ( p = 0.005). With analysis of covariance, pain-sensitive group was found to have higher global PSQI scores (adjusted mean 5.76, 95% CI 5.29; 6.22) than pain-tolerant participants (adjusted mean 4.42, 95% CI 3.52; 5.32) ( p = 0.010).

          Conclusions. Majority of opioid-dependent male patients on methadone treatment are pain-sensitive with CPT. Poor sleep quality is associated with cold pressor pain-sensitivity. Pain and sleep complaints in this male population should not be overlooked.

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          Diagnostic and statistical manual of mental disorders.

          Vijay A. Mittal, Elaine Walker (2011)
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            A systematic literature review of 10 years of research on sex/gender and experimental pain perception - part 1: are there really differences between women and men?

            Mélanie Racine, Yannick Tousignant-Laflamme, Lorie A Kloda … (2012)
            The purpose of this systematic review was to summarize and critically appraise the results of 10 years of human laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian and conducted in multiple databases. A total of 172 articles published between 1998 and 2008 were retrieved, analyzed, and synthesized. The first set of results (122 articles), which is presented in this paper, examined sex difference in the perception of laboratory-induced thermal, pressure, ischemic, muscle, electrical, chemical, and visceral pain in healthy subjects. This review suggests that females (F) and males (M) have comparable thresholds for cold and ischemic pain, while pressure pain thresholds are lower in F than M. There is strong evidence that F tolerate less thermal (heat, cold) and pressure pain than M but it is not the case for tolerance to ischemic pain, which is comparable in both sexes. The majority of the studies that measured pain intensity and unpleasantness showed no sex difference in many pain modalities. In summary, 10 years of laboratory research have not been successful in producing a clear and consistent pattern of sex differences in human pain sensitivity, even with the use of deep, tonic, long-lasting stimuli, which are known to better mimic clinical pain. Whether laboratory studies in healthy subjects are the best paradigm to investigate sex differences in pain perception is open to question and should be discussed with a view to enhancing the clinical relevance of these experiments and developing new research avenues. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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              Gender differences in sleep disorders.

              Viswanathan Krishnan, Nancy Collop (2006)
              To evaluate recent evidence regarding gender differences in sleep. Women have better sleep quality compared with men, with longer sleep times, shorter sleep-onset latency and higher sleep efficiency. Despite this, women have more sleep-related complaints than men. The amount of slow-wave sleep decreases with age in men and women. Normal physiologic periods, including puberty, menstruation, pregnancy, and menopause, are associated with alterations in sleep patterns. Gender differences in normal sleep may underlie the observed differences in risk of sleep disorders. Studies of insomnia support a female predominance, with increased divergence of prevalence between men and women with older age. Recent findings for the gender differences in obstructive sleep apnea have focused on differences in local neuromuscular reflexes and central ventilatory control. Restless legs syndrome has a slight female predominance, whereas rapid eye movement sleep behavior disorder and Kleine-Levin syndrome are more common in men. Gender differences in sleep become apparent after the onset of puberty. Menstrual cycles, pregnancy, and menopause can alter sleep architecture. Gender-related differences in sleep disorders, such as obstructive sleep apnea, insomnia, and restless legs syndrome, include differences in prevalence, pathophysiology, clinical presentation, and response to therapy.
              Article 0 comments Cited 133 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Zalina Zahari
                Journal
                Journal ID (nlm-ta): PeerJ
                Journal ID (iso-abbrev): PeerJ
                Journal ID (pmc): PeerJ
                Journal ID (publisher-id): PeerJ
                Title: PeerJ
                Publisher: PeerJ Inc. (San Francisco, USA )
                ISSN (Electronic): 2167-8359
                Publication date (Electronic): 9 April 2015
                Publication date Collection: 2015
                Volume: 3
                Electronic Location Identifier: e839
                Affiliations
                [1 ]Department of Pharmacy, Hospital Universiti Sains Malaysia , Kubang Kerian, Kelantan, Malaysia
                [2 ]Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia , Kubang Kerian, Kelantan, Malaysia
                [3 ]Department of Emergency Medicine, School of Medical Sciences , Kubang Kerian, Kelantan, Malaysia
                [4 ]Faculty of Medicine & Health Sciences, Universiti Sultan Zainal Abidin , Kuala Terengganu, Terengganu, Malaysia
                [5 ]School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Kelantan, Malaysia
                [6 ]Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia
                Article
                Publisher ID: 839
                DOI: 10.7717/peerj.839
                PMC ID: 4393806
                SO-VID: 772b4945-2b3b-4d10-80da-5df83acab3f9
                Copyright © © 2015 Zahari et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.

                History
                Date received : 14 November 2014
                Date accepted : 25 February 2015
                Funding
                Funded by: Universiti Sains Malaysia (USM) Research University (RU) Grant
                Award ID: 1001.PSK.8620014
                This study was supported by the Universiti Sains Malaysia (USM) grant under the ‘Research University Cluster (RUC)’ Grant No.1001.PSK.8620014, under the project; Application of Personalised Methadone Therapy Methadone Maintenance Therapy (PMT for MMT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Anaesthesiology and Pain Management
                Subject: Drugs and Devices
                Subject: Internal Medicine
                Subject: Nursing
                Subject: Pharmacology

                Keywords: methadone maintenance therapy,pain,sleep quality,opioid-dependence,pain-tolerance,pain-sensitivity
                Data availability:
                Keywords: methadone maintenance therapy, pain, sleep quality, opioid-dependence, pain-tolerance, pain-sensitivity

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