The Sleep-Pain Relationship in Fibromyalgia: Insight From Previous Clinical Trials
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Authors
Abolhosseini, Shokouh
Date
2024-09-19
Type
thesis
Language
eng
Keyword
fibromyalgia , sleep , meta-analysis , pain , systematic review
Alternative Title
Abstract
Introduction: Fibromyalgia is a chronic condition marked by widespread musculoskeletal pain, poor sleep, depression, and impaired physical functioning, affecting 2–8% of the population. Due to our incomplete understanding of pathophysiological mechanisms, current fibromyalgia treatments have limited efficacy. In this thesis, I investigated a new pathophysiological hypothesis with sleep problems as a predictor of pain severity in adults with fibromyalgia. Objectives: I conducted a systematic review and meta-analyses to evaluate whether pharmacological and non-pharmacological sleep interventions improved pain and sleep in people with fibromyalgia. In addition, I longitudinally investigated the Sleep and Pain Diathesis (SAPD) model to clarify the relationships among a prominent group of fibromyalgia symptoms. Methods: I performed a systematic review according to PRISMA guidelines and conducted bivariate random-effects meta-analyses on pain and sleep outcomes using R. I also conducted a cross classified longitudinal mediation on data from a fibromyalgia trial (Gilron et al., 2016) in MPlus. Results: The systematic review included 18 trials, with 10 trials included in meta-analyses of sleep interventions for pain and sleep outcomes. Sodium oxybate and cognitive behavioral therapy (CBT) for insomnia significantly improved both pain and sleep compared to placebo and usual care. However, I found no significant differences when comparing CBT for insomnia to sleep hygiene training or combined CBT for insomnia and pain to CBT for pain alone. Other identified interventions (e.g., melatonin) had insufficient data for meta-analysis. The longitudinal mediation analysis did not support the hypothesized relationships within the SAPD model. There was no evidence for an association between sleep and pain, with significant variance in the data. Discussion: The review provided preliminary support for the analgesic benefits of some sleep interventions, although concerns about evidence quality were raised. The findings suggested that the SAPD model may not fully explain the relationship between prominent fibromyalgia symptoms. However, this may in part be explained by the limitations of the dataset (e.g., small sample, different medication regimens). Future research should investigate the long-term effects of sleep interventions on pain to better inform fibromyalgia treatment plans.
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Attribution-NonCommercial-ShareAlike 4.0 International
Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.