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 "In older adults widespread pain, that is pain that
affects multiple sites in the body, is common and is associated with
morbidity and disability including poor mental health and reduced
physical functioning," said Ross Wilkie, the study's senior author.
Wilkie is a researcher with the Arthritis Research UK Primary Care
Center of Keele University in Staffordshire.
"In this study, reporting musculoskeletal pain was common with just
under half of participants reporting some pain and one quarter
reporting widespread pain," Wilkie told Reuters Health in an email.
"Non-restorative sleep was the strongest predictor of new onset
widespread pain," he said, and "sleep is a modifiable target," so
improving it might improve the outcomes of these people, he said.
"In addition to sleep, osteoarthritis, cognitive impairment, anxiety
and physical health independently predicted the onset of widespread
pain and are important treatment targets," he added.
Widespread pain is the main feature of fibromyalgia, a condition
affecting 15 percent of women and 10 percent of men over the age of
50, according to Wilkie and his colleagues, who published their
report in the journal Arthritis and Rheumatology.
But the factors that influence who develops widespread pain with age
are poorly understood, they write. To investigate, the researchers
analyzed data on 4,326 adults from North Staffordshire, England.
All were over age 50 and free of widespread pain at the start of the
study, although 2,764 had some localized pain.
Participants were surveyed about their pain, their physical and
emotional health and lifestyle factors at the beginning of the
study. Then they took the same survey again three years later.
At the follow-up, 19 percent reported new widespread pain, with
women more likely to have experienced the onset of widespread pain
than men.
When the researchers looked for factors linked to developing
widespread pain during the time between surveys, they found that
having reported some pain on the original survey, as well as having
anxiety, physical health or cognitive problems and osteoarthritis
were all predictors.
But regularly having poor, "non-restorative" sleep showed the
strongest link, making a person almost twice as likely to experience
the onset of widespread pain compared to people without sleep
problems.
The study cannot prove that unrestful sleep is either a cause or
effect of widespread pain, but more research is needed to understand
the relationship, Wilkie and his colleagues write. That may also
offer targets for reducing pain.
At present, current management and treatment of musculoskeletal pain
in older adults is less than optimal, Wilkie said.
"Clinical approaches that target multiple sites of osteoarthritis
may be useful," he said. "However, the clinical approach to managing
widespread pain in older adults may need to move beyond focusing on
treatment of osteoarthritis and consider combined interventions."
Treatment options to improve sleep are limited, Wilkie added, and
existing pharmacological sleep aids can be problematic in older
adults.
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"Psychological and other non-pharmacological
treatments may be beneficial," Wilkie said, but there's a need for
both drug and non-drug treatments to be more thoroughly tested in
clinical trials.
"It's interesting because they looked at people who were pain-free
and they followed them over time" to see who developed widespread
pain, Dr. Babak Mokhlesi said, "I think that's what gives (the
study) so much strength."
Mokhlesi is director of the Sleep Disorders Center as well as the
Sleep Medicine Fellowship training program at the University of
Chicago. He was not involved in the UK study.
"Typically what happens is that you don't know what came first — does bad sleep cause pain or is the pain causing bad sleep — you
don't know what's causing what," Mokhlesi told Reuters Health.
Retired and elderly people frequently come to his office and ask why
they can't sleep more than eight hours, he said.
Among the things he tells them is to avoid "reducing time in bed" by
going to sleep late or getting up early "so that you can get enough
hours of sleep," he said.
On the other hand, spending a lot of time in bed with lights,
televisions and other electronic devices on is also not conducive to
rest, he said.
"Engaging in behavior like that can actually promote insomnia, so I
always tell people, ‘you don't want to spend excessive amounts of
time in bed or go to bed when you're not sleepy because that creates
a vicious cycle for insomnia'," he said.
"The other thing that we always tell people is that as a
society as we've been gaining weight and we're an aging society,
that also brings about increased risk for other sleep disorders like
sleep breathing disorders like sleep apnea, restless legs, and
insomnia," Mokhlesi said.
He added that those are things that people typically don't pay
attention to and they don't even discuss it with their physicians.
"There might be a lot of opportunity there for physicians to help
their patients to improve their sleep," he said.
The U.S. National Institutes of Health offers a guide to healthy
sleep here: http://1.usa.gov/1cnucMC
(PDF).
___
Source: http://bit.ly/1cV7fNu
Arthritis and Rheumatology, online Feb. 13, 2014.
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