Knee osteoarthritis, a leading cause of pain and disability in older
adults, occurs when flexible tissue at the ends of bones wears down.
While it can’t be cured, physical therapy or anti-inflammatory
medications are often prescribed to relieve pain and improve
More than 70 percent of people with knee osteoarthritis also suffer
from sleep disturbances, researchers note in the journal Pain.
For the current study, researchers randomly assigned 100 people with
both insomnia and knee osteoarthritis to receive eight sessions of
either cognitive behavioral therapy for insomnia (CBT-I), designed
to shift thinking about sleep and bad habits that contribute to
insomnia, or behavior desensitization therapy designed to diminish
emotional and physical responses to arousing thoughts and behaviors
related to sleep."
Researchers assessed participants’ perceptions of pain before
treatment and again three and six months after the interventions
finished. The study team expected the CBT-I to achieve a greater
reduction in what’s known as pain catastrophizing, or feeling
exaggerated levels of pain that are amplified by being emotionally
upset about the pain. Instead, they found similar reductions in
negative perceptions of pain with both the cognitive behavioral
therapy and behavior desensitization.
“Sleep is really important and when it is compromised like in
insomnia it can increase the risk for many negative health outcomes,
including chronic pain, depression, obesity, high blood pressure and
more,” said lead study author Sheera Lerman, a behavioral health
researcher at Johns Hopkins University School of Medicine in
“The good news is that for most people with insomnia, it can be
effectively treated without using medication,” Lerman said by email.
Regardless of what intervention they received, participants
experienced fewer negative feelings about both daytime and nighttime
pain by the end of treatment, and this persisted three and six
People who had greater reductions in nighttime awakenings early in
the study also had a larger decline in negative feelings about pain
than people who didn’t experience this type of sleep improvement
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The results suggest that even brief interventions focused on sleep
improvement may make a big dent in negative feelings people have
about their pain, the authors conclude.
One limitation of the study is that people started out with
relatively low levels of pain catastrophizing, and there might have
been a bigger effect from treatment or a larger difference between
therapies if participants had more intense negative feelings about
their pain, the researchers note.
Without these therapies, there are still many things patients can do
to improve their sleep routines that may also influence how they
experience pain, said Jean-Michel Brismee, a researcher at Texas
Tech University Health Sciences Center in Lubbock who wasn’t
involved in the study.
Going to bed and waking up at the same time every day can help, as
can eating well, avoiding big meals and caffeine in the hours right
before bedtime, and getting plenty of exercise, Brismee said by
“If you have knee osteoarthritis, walking may hurt . . . so find
some activities that do not increase the pain such as tai chi, yoga,
and cycling,” Brismee said.
“Do gentle breathing exercises for a couple of minutes while in
bed,” Brismee added. “They can lower the activity of your
sympathetic nervous system and improve your sleep.”
SOURCE: http://bit.ly/2vW8D7f Pain, online July 31, 2017.
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