Kristian McCarthy1, Aparna Saripella1, Janannii Selvanathan1, Mahesh Nagappa2, Marina Englesakis3, David Wang4,5, Philip Peng1, Frances Chung6. 1. Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, MCL 2-405, 399 Bathurst St, Toronto, M5T 2S8, ON, Canada. 2. Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Western University, London, Ontario, Canada. 3. Library and Information Services, University Health Network, Toronto, Canada. 4. Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, Australia. 5. Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, The University of Sydney, Sydney, Australia. 6. Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, MCL 2-405, 399 Bathurst St, Toronto, M5T 2S8, ON, Canada. frances.chung@uhn.ca.
Abstract
PURPOSE: Obstructive sleep apnea (OSA) is prevalent in patients with chronic non-cancer pain. OSA may lead to low sleep quality and an increase in pain sensitivity. Patients reporting greater sleep impairment tend to experience higher pain intensity and vice versa. Positive airway pressure (PAP) is the current gold standard treatment for OSA. This review aims to evaluate the efficacy of PAP therapy in patients with comorbid chronic pain and OSA in influencing pain outcomes like pain intensity, tolerance, threshold, and sensitivity. METHODS: We performed a systematic literature search for studies published after 1990, utilizing the following databases: Medline, Medline In-Process/ePubs, Embase, Cochrane CENTRAL, and the Cochrane Database of Systematic Reviews. Search terms included "chronic pain," "sleep disorders," and "positive airway pressure." RESULTS: Of 1982 initial studies, ten studies met the study inclusion criteria. Seven of these studies examined the effect of PAP therapy on chronic pain, of which five demonstrated improved pain outcomes, specifically, headache pain. The effect of PAP therapy on chronic non-headache pain was found to be inconclusive. When examining the three studies that did not involve chronic pain patients, PAP therapy effectively increased pain threshold and tolerance in two studies (p = 0.03 and p = 0.01). CONCLUSION: An association exists between PAP therapy and decreased chronic headache outcomes in patients with OSA. Additionally, research shows that PAP therapy may increase pain tolerance and threshold. Future high-quality evidence is required to further investigate the association between PAP and non-headache chronic pain.
PURPOSE: Obstructive sleep apnea (OSA) is prevalent in patients with chronic non-cancer pain. OSA may lead to low sleep quality and an increase in pain sensitivity. Patients reporting greater sleep impairment tend to experience higher pain intensity and vice versa. Positive airway pressure (PAP) is the current gold standard treatment for OSA. This review aims to evaluate the efficacy of PAP therapy in patients with comorbid chronic pain and OSA in influencing pain outcomes like pain intensity, tolerance, threshold, and sensitivity. METHODS: We performed a systematic literature search for studies published after 1990, utilizing the following databases: Medline, Medline In-Process/ePubs, Embase, Cochrane CENTRAL, and the Cochrane Database of Systematic Reviews. Search terms included "chronic pain," "sleep disorders," and "positive airway pressure." RESULTS: Of 1982 initial studies, ten studies met the study inclusion criteria. Seven of these studies examined the effect of PAP therapy on chronic pain, of which five demonstrated improved pain outcomes, specifically, headache pain. The effect of PAP therapy on chronic non-headache pain was found to be inconclusive. When examining the three studies that did not involve chronic pain patients, PAP therapy effectively increased pain threshold and tolerance in two studies (p = 0.03 and p = 0.01). CONCLUSION: An association exists between PAP therapy and decreased chronic headache outcomes in patients with OSA. Additionally, research shows that PAP therapy may increase pain tolerance and threshold. Future high-quality evidence is required to further investigate the association between PAP and non-headache chronic pain.
Authors: R Heinzer; S Vat; P Marques-Vidal; H Marti-Soler; D Andries; N Tobback; V Mooser; M Preisig; A Malhotra; G Waeber; P Vollenweider; M Tafti; J Haba-Rubio Journal: Lancet Respir Med Date: 2015-02-12 Impact factor: 30.700
Authors: S-Hakki Onen; Fannie Onen; Gilles Albrand; Evelyne Decullier; François Chapuis; Claude Dubray Journal: J Am Med Dir Assoc Date: 2010-11 Impact factor: 4.669