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Frange C.1, Naufel M.F.2, Ribeiro E.B.2, Tufik S.1, Girão M.J.B.C.3, Andersen M.L.1, Hachul H.1,3
1Universidade Federal de São Paulo, Psychobiology, São Paulo, Brazil, 2Universidade Federal de São Paulo, Nutrition, São Paulo, Brazil, 3Universidade Federal de São Paulo, Gynecology, São Paulo, Brazil
Background: Pain has a negative impact on quality of life. Chronic pain is common among women, especially in postmenopausal stage due to a variety of symptoms such as musculoskeletal (osteoarthritis, fibromyalgia) and menopausal (vasomotor symptoms, fatigue, sleep disorders). Insomnia seems to be closely related to pain conditions. Insomnia complaints are associated with the severity of pain. Sleep is a critical outcome for women with chronic pain because sleep disturbances increase pain sensitivity and risk for pain-related disability, depression and health problems. Importantly, pain and sleep disorders can have a substantial impact on quality of life.
Purpose: To investigate how insomnia is associated with pain intensity and pain interference on daily function in postmenopausal women.
Methods: We conducted a study analyzing sleep parameters, both in a subjective and objective ways, self-reported pain and menopausal symptomatology. One hundred and seven patients at postmenopausal stage and with sleep complaints from the Ambulatory of Integrative Treatment for Female Sleep Disorders were invited by telephone to participate in this study. We included women aged 50 to 70 years (n=84) and exclude the use of hormone therapy (n=8), sleep apnea diagnosis (n=14), missing data (n=5) and inadequate completion of questionnaires (n=7). The study consisted in 2 meetings, where they answered questionnaires, either self-reported or with our help for illiterate or low-literacy patients. Menopausal status was confirmed by amenorrhea for at least 1 year and a medical appointment. Patients answered questionnaires about insomnia (Insomnia Severity Index), menopausal symptoms (Blatt-Kupperman Menopausal Index) and pain (Brief Pain Inventory) and underwent full night polysomnography exam. Patients completed a form on age, use of hormone therapy, presence of hot flashes, previous diseases and social data. Weight and height were measured to calculate body mass index (BMI). Patients were allocated into 3 groups according to their complaints of insomnia: control; subthreshold insomnia and insomnia. Pain intensity and menopausal symptoms were compared between groups.
Results: In this cross-sectional analysis of 57 postmenopausal women, pain interference on daily function but not pain intensity significantly differ amongst women with insomnia. The insomnia group had statistically significant higher pain interference in their activities (such as relationship with other people, enjoyment of life and sleep) than controls. Interestingly, there was no statistically significant difference on pain intensity. Regarding menopausal symptoms, the insomnia group had more severe menopausal symptoms. No significantly difference was observed in sleep parameters through the polysomnography between groups, indicating no significantly differences in sleep architecture.
Conclusion(s): Pain in postmenopausal women with insomnia interferes or limits their daily activities. Postmenopausal women with insomnia perceive pain differently, despite its intensity and age did not influence this association. Postmenopausal women with insomnia had worse menopausal symptoms than those without insomnia or subthreshold insomnia beyond pain interference.
Implications: For women, the expectancy is to live one third of their lives at postmenopausal stage. Knowing conditions of these specific stage of life is of huge importance. The assessment of sleep conditions such as insomnia requires attention in clinical evaluation to develop physiotherapeutic treatments for menopause symptomatology and sleep conditions.
Funding acknowledgements: AFIP (Associação Fundo Incentivo a Pesquisa); São Paulo Research Foundation (FAPESP #2014/18722-5); Conselho Nacional de Desenvolvimento Científico e Tecnológico (#158506/2014-6).
Topic: Health promotion & wellbeing/healthy ageing
Ethics approval: The study were approved by the Ethical Committee of UNIFESP (CEP #834146/2014).
All authors, affiliations and abstracts have been published as submitted.
