The Importance of Sleep for People With Chronic Pain:Current Insights and Evidence

ABSTRACT We are currently in the midst of a sleep crisis. Our current work and lifestyle environments are normalizing poor sleep with substantial negative impact on our health. Research on sleep has linked sleep deprivation to poorer mental health, obesity, cancer, diabetes, heart disease, and a myriad of other health conditions. Sleep deprivation is an even greater issues for people with musculoskeletal conditions and chronic pain. Between 67% and 88% of individuals with chronic pain experience sleep disruption and insomnia, and at least 50% of people with insomnia report chronic pain. The link between sleep and pain is well documented. Experimental, cohort, and longitudinal studies have all demonstrated that restricted sleep is linked to greater pain. Poor sleep therefore not only affects general health but has a direct impact on inflammation, pain response, and experience. Improving sleep in people living with musculoskeletal conditions and with chronic pain has the potential to deliver great benefit to many. This article describes the evidence base that can underpin such work, including research about the link between pain and sleep as well as theories and approaches to intervention that may help. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research

Development of a novel intervention to improve sleep and pain in patients undergoing total knee replacement

BACKGROUND: Up to 20% of patients experience long-term pain and dissatisfaction after total knee replacement, with a negative impact on their quality of life. New approaches are needed to reduce the proportion of people to go on to experience chronic post-surgical pain. Sleep and pain are bidirectionally linked with poor sleep linked to greater pain. Interventions to improve sleep among people undergoing knee replacement offer a promising avenue. Health beliefs and barriers to engagement were explored using behaviour change theory. This study followed stages 1–4 of the Medical Research Council’s guidance for complex intervention development to develop a novel intervention aimed at improving sleep in pre-operative knee replacement patients. METHODS: Pre-operative focus groups and post-operative telephone interviews were conducted with knee replacement patients. Before surgery, focus groups explored sleep experiences and views about existing sleep interventions (cognitive behavioural therapy for insomnia, exercise, relaxation, mindfulness, sleep hygiene) and barriers to engagement. After surgery, telephone interviews explored any changes in sleep and views about intervention appropriateness. Data were audio-recorded, transcribed, anonymised, and analysed using framework analysis. RESULTS: Overall, 23 patients took part, 17 patients attended pre-operative focus groups, seven took part in a post-operative telephone interview, and one took part in a focus group and interview. Key sleep issues identified were problems getting to sleep, frequent waking during the night, and problems getting back to sleep after night waking. The main reason for these issues was knee pain and discomfort and a busy mind. Participants felt that the sleep interventions were generally acceptable with no general preference for one intervention over the others. Views of delivery mode varied in relation to digital move and group or one-to-one approaches. CONCLUSION: Existing sleep interventions were found to be acceptable to knee replacement patients. Key barriers to engagement related to participants’ health beliefs. Addressing beliefs about the relationship between sleep and pain and enhancing understanding of the bidirectional/cyclical relationship could benefit engagement and motivation. Individuals may also require support to break the fear and avoidance cycle of pain and coping. A future intervention should ensure that patients’ preferences for sleep interventions and delivery mode can be accommodated in a real-world context

Empirically derived user attributes for the design of home healthcare technologies

Designing effective home healthcare technologies is a complex task. In order to succeed, it is important to look beyond purely technology-driven solutions and to develop technologies and services that are flexible and reflect a sensitive understanding of the diverse users of such systems. The key contribution of this paper is to introduce 15 empirically derived attributes that can help designers to build a more detailed understanding of the potential users of home healthcare systems. The attributes are spread across four broad themes: technology in the home, experiences of technology, experiences of health and care, and thoughts about smart home technology for health and care. These themes and attributes emerged from an ethnographic study in which we interviewed people across 15 households. All interviews took place in people’s homes and were supplemented by home technology tours and cultural probes. It is intended that the 15 attributes be used in conjunction with demographic and household data to build a richer picture of personal experiences of home, health, and technology in real-life contexts. The aim was to provide an inclusive framework, based on empirically derived attributes, that helps to inform an overall user-centred design approach. To demonstrate one application of the attributes in design, the paper provides in-depth example of their use in the development of a rich set of data-driven personas.SPHERE-IRCUK Engineering and Physical Sciences Research Council (EPSRC