User experiences of pre-sleep sensory alpha brainwave entrainment for people with chronic pain and sleep disturbance.

Aim: To explore the user experiences of pre-sleep alpha entrainment via a smartphone-enabled audio or visual stimulation program for people with chronic pain and sleep disturbance. Materials & methods: Semi-structured interviews were held with 27 participants completing a feasibility study of pre-sleep entrainment use for 4 weeks. Transcriptions were subject to template analysis. Results: Five top-level themes generated from this analysis are presented. These report on participants' impressions of the pain-sleep relationship, their previous experiences of strategies for these symptoms, their expectations and their experience of use and perceived impact on symptoms of audiovisual alpha entrainment. Conclusion: Pre-sleep audiovisual alpha entrainment was acceptable to individuals with chronic pain and sleep disturbance and perceived to have symptomatic benefits.

In this study, people who had used an experimental treatment for chronic pain called alpha entrainment, which was delivered by audio (tones through headphones) or visual (flickering light) stimulation just before sleep each night for 4 weeks, were interviewed about their experiences. Analysis of the interview transcripts generated findings in five large areas: participants' impressions of the relationship between pain and sleep, previous strategies they had tried, expectations of using this intervention and their experiences of using it and how it affected their symptoms. Overall, participants found using this type of sensory stimulation last thing at night to be acceptable in a real-life setting, consistent with prior understanding, and many felt it to have benefits for sleep and pain symptoms with few side effects. Comfort of the equipment and having the choice of different types of stimulation were important. Further development should be guided by these user experiences.

Mental Defeat and Suicidality in Chronic Pain: A Prospective Analysis.

Living with chronic pain has been identified as a significant risk factor for suicide. Qualitative and cross-sectional studies have reported an association between mental defeat and suicidal thoughts and behavior in patients with chronic pain. In this prospective cohort study, we hypothesized that higher levels of mental defeat would be associated with increased suicide risk at a 6-month follow-up. A total of 524 patients with chronic pain completed online questionnaires measuring variables related to suicide risk, mental defeat, sociodemographic, psychological, pain, activity, and health variables. At 6 months, 70.8% (n = 371) of respondents completed the questionnaires again. Weighted univariate and multivariable regression models were run to predict suicide risk at 6 months. The clinical suicide risk cutoff was met by 38.55% of the participants at baseline and 36.66% at 6 months. Multivariable modeling revealed that mental defeat, depression, perceived stress, head pain, and active smoking status significantly increased the odds of reporting higher suicide risk, while older age reduced the odds. Receiver operating characteristic (ROC) analysis showed that assessment of mental defeat, perceived stress, and depression is effective in discriminating between 'low' and 'high' suicide risk. Awareness of the prospective links from mental defeat, depression, perceived stress, head pain, and active smoking status to increased suicide risk in patients with chronic pain may offer a novel avenue for assessment and preventative intervention. PERSPECTIVE: Results from this prospective cohort study suggest that mental defeat is a significant predictor of increased suicide risk among patients with chronic pain, along with depression, perceived stress, head pain, and active smoking status. These findings offer a novel avenue for assessment and preventative intervention before risk escalates.

Development of a hybrid sleep and physical activity improvement intervention for adults with osteoarthritis-related pain and sleep disturbance: a focus group study with potential users.

Objective: Suboptimal sleep and physical activity are common among people living with osteoarthritis (OA) and simultaneous improvements in both may have a beneficial impact on pain. This study aimed to gather perspectives of people living with OA on important aspects to incorporate in a hybrid sleep and physical activity improvement intervention for OA pain management. Design: Qualitative study using two rounds of two focus groups. Setting and participants: Focus groups were conducted with adults living with OA-related chronic pain and sleep disturbances. Eighteen people attended focus groups in January 2020 and, of these, 16 attended subsequent focus groups in February 2020. Methods: Discussion at the first round of focus groups informed generation of prototype intervention materials that were shared, discussed and refined at the second round of focus groups. Thematic analysis was used to identify themes and sub-themes from the data. Results: Three themes, each with three sub-themes, were identified: facilitators of engagement with the intervention (sub-themes: motivational language, accountability and education); barriers to engagement (sub-themes: suboptimal interaction with healthcare practitioners, recording behaviour as burdensome/disruptive and uncertainty about technique) and characteristics of a physical activity intervention component (sub-themes: tailored, sustainable and supported). Conclusion: We have identified important aspects to incorporate into the design and delivery of a hybrid sleep and physical activity improvement intervention for OA pain management. Insights will be incorporated into intervention materials and protocols, with feasibility and acceptability assessed in a future study.

Bidirectional association between disturbed sleep and neuropathic pain symptoms: a prospective cohort study in post-total joint replacement participants.

BACKGROUND: Disturbed sleep is strongly correlated with chronic pain. The aim of this study was to examine the association between sleep disturbance and incident joint pain focusing on neuropathic-like pain symptoms. METHODS: A total of 423 individuals who had undergone total joint replacement (TJR) for osteoarthritis were assessed at the mean time of 3.6 years post-surgery and again at 5.9 years post-TJR, using the Medical Outcomes Survey sleep subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and painDETECT questionnaire instruments. Cox hazard ratios (HRs) and 95% confidence intervals (CIs) were computed adjusting for age, body mass index, sex, and use of hypnotic and analgesic medication. RESULTS: The presence of neuropathic pain symptoms predicted incidence of disturbed sleep after adjustment for covariates and pain severity (adjusted HR [aHR] 2.01, 95% CI: 1.00-4.10; p<0.05). There was no association between joint pain and incidence of disturbed sleep when individuals with neuropathic pain symptoms at the baseline visit were excluded (aHR 1.11, 95% CI: 0.47-2.67). Disturbed sleep at baseline predicted incident neuropathic joint pain symptoms (aHR 2.75, 95% CI: 1.21-6.26; p<0.016) but had no effect on incidence of joint pain when all types of pain were considered together (aHR 0.63, 95% CI: 0.30-1.39). CONCLUSION: These data suggest a causal bidirectional link between sleep disturbance and joint pain with neuropathic features but not with other types of joint pain.

Thinking about thinking about pain: a qualitative investigation of rumination in chronic pain.

UNLABELLED: SUMMARY  AIMS: A thinking process central to the etiology of emotional disorders, rumination is commonly observed in chronic pain. However, very little is understood about the characteristics of pain-related rumination and the mechanisms through which rumination impacts on pain perception and disability. This study began investigating this cognitive phenomenon by qualitatively examining chronic pain patients' experience of rumination. METHODS: Semistructured interviews were conducted with 20 chronic pain patients. Themes were extracted from interview transcripts using thematic analysis. RESULTS: Six themes were extracted from interviews with frequent ruminators. These elucidated the pattern of rumination and suggested a reciprocal relationship of rumination with not only pain, but also negative emotions and sleeplessness. Frequent ruminators appeared to hold positive beliefs about rumination and negative beliefs about self in overcoming pain. Two themes were extracted from interviews with infrequent ruminators: implicating negative beliefs about rumination and the flexible use of disengagement strategies in these individuals. CONCLUSION: Rumination occurs frequently and can be easily triggered by pain, negative emotions and sleeplessness in patients who lack alternative coping strategies and believe rumination is a way to problem-solve. A tentative model of pain-related rumination has been proposed, outlining interesting hypotheses for rigorous empirical investigations.