A dissertation submitted to the Faculty of Health Science, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in medicine. Johannesburg 2014 / Introduction: The presence of pain during sleep causes patients with chronic daily pain, such as in Rheumatoid and Osteoarthritis, to experience insomnia, fragmented sleep and an increased number of night-time awakenings. This poor sleep results in an increased sensitivity to pain during the day. The effect of improving sleep on pain, sleep and mood after taking Zolpidem MR was the aim of this study. Methods: 11 patients from Chris Hani Baragwanath Hospital in Soweto South Africa who reported insomnia and daily pain spent 4 weeks in this crossover design, double blinded, placebo controlled study. Week 1- baseline, week 2 and 4 were Intervention weeks – either placebo or Zolpidem MR, week 3 was a Washout week. Data collected included actigraphy, McGill Pain Questionnaire, PSQI, BDI, physical activity questionnaire and daily sleep and pain diaries containing VAS scales for sleep and pain. Results: No significant changes were found in the pain or physical activity levels in any of the patients. Sleep quality, as measured by an isolated PSQI question, was improved by Zolpidem MR (p=0.0075). PSQI was decreased in the final week of the study compared to baseline (8.7 vs. 11.3, p=0.0106) and BDI was lower in week 4 than baseline (7.7 vs. 15.85, p=0.0003), BDI was also lower in week 4 compared to week 2 (7.7 vs. 12.8, p<0.05). However the changes in PSQI and BDI were a result of the order of the weeks, with patients interacting with the researcher and were not due to either Zolpidem MR or placebo. Anecdotal reports include feeling more energised and capable of living life. Conclusion: This study has shown that human interaction is an important component of treatment for insomnia and chronic pain as there is a positive effect on sleep disruption and depression.

Ko, Wai Man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 243-257). / Abstracts in English and Chinese. / Publications Based On The Work In This Thesis --- p.i / Abstract --- p.ii / Acknowledgements --- p.ix / Abbreviations --- p.x / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Prevalence of arthritis --- p.1 / Chapter 1.2 --- Pathogenesis of arthritis --- p.4 / Chapter 1.2.1 --- Histological changes --- p.6 / Chapter 1.2.1.1 --- Synovium changes --- p.6 / Chapter 1.2.1.2 --- Articular cartilage degradation --- p.8 / Chapter 1.2.1.3 --- Bone erosions --- p.10 / Chapter 1.3 --- Western medicines for arthritis --- p.14 / Chapter 1.3.1 --- Nonsteroidal anti-inflammatory drugs (NSAIDs) --- p.15 / Chapter 1.3.2 --- Glucocorticoids (GCs) --- p.18 / Chapter 1.3.3 --- Disease modifying antirheumatic drugs (DMARDs) --- p.20 / Chapter 1.3.4 --- Biological therapies --- p.22 / Chapter 1.4 --- Traditional Chinese medicines for arthritis --- p.24 / Chapter 1.4.1 --- Ganoderma lucidum (靈芝））) --- p.26 / Chapter 1.4.1.1 --- Major chemical constituents --- p.27 / Chapter 1.4.1.2 --- Functions --- p.27 / Chapter 1.4.2 --- Cortex Phellodendri (黃柏） --- p.28 / Chapter 1.4.2.1 --- Major chemical constituents --- p.29 / Chapter 1.4.2.2 --- Traditional description --- p.29 / Chapter 1.4.2.3 --- Functions --- p.30 / Chapter 1.4.3 --- Atractylodisa Rhizoma (蒼术) --- p.31 / Chapter 1.4.3.1 --- Major chemical constituents --- p.31 / Chapter 1.4.3.2 --- Traditional description --- p.32 / Chapter 1.4.3.3 --- Functions --- p.32 / Chapter 1.4.4 --- Radix Achyranthis Bidentatae (牛膝) --- p.33 / Chapter 1.4.4.1 --- Major chemical constituents --- p.34 / Chapter 1.4.4.2 --- Traditional description --- p.34 / Chapter 1.4.4.3 --- Functions --- p.34 / Chapter 1.5 --- Animal models of arthritis --- p.36 / Chapter 1.5.1 --- Adjuvant-induced arthritis --- p.37 / Chapter 1.6 --- Aims of study --- p.42 / Chapter Chapter 2 --- Materials and Drugs --- p.44 / Chapter Chapter 3 --- Methodology --- p.49 / Chapter 3.1 --- Induction of anaesthesia --- p.49 / Chapter 3.2 --- Induction of monoarthritis --- p.49 / Chapter 3.3 --- Measurements of knee extension angles --- p.50 / Chapter 3.4 --- Measurements of knee joint sizes --- p.51 / Chapter 3.5 --- Assessment of changes in articular blood flow --- p.52 / Chapter 3.6 --- Assessment of morphological changes --- p.53 / Chapter 3.6.1 --- Fixation --- p.53 / Chapter 3.6.2 --- Decalcification --- p.53 / Chapter 3.6.3 --- Processing --- p.54 / Chapter 3.6.4 --- Embedding --- p.54 / Chapter 3.6.5 --- Sectioning --- p.55 / Chapter 3.6.6 --- Staining --- p.55 / Chapter 3.6.7 --- Scoring --- p.56 / Chapter 3.7 --- Statistical analysis --- p.57 / Chapter Chapter 4 --- Adjuvant-induced Monoarthritic Rats / Chapter 4.1 --- Adjuvant-induced monoarthritic rats (1 week) --- p.58 / Chapter 4.1.1 --- Method --- p.58 / Chapter 4.1.2 --- Results --- p.59 / Chapter 4.1.2.1 --- Body weight --- p.59 / Chapter 4.1.2.2 --- Knee joint sizes --- p.59 / Chapter 4.1.2.3 --- Knee extension angles --- p.59 / Chapter 4.1.2.4 --- Knee joint blood flow --- p.60 / Chapter 4.1.2.5 --- Histological evaluation --- p.60 / Chapter 4.1.2.5.1 --- Cell infiltration --- p.60 / Chapter 4.1.2.5.2 --- Synovial tissue proliferation --- p.61 / Chapter 4.1.2.5.3 --- Cartilage degradation --- p.61 / Chapter 4.2 --- Adjuvant-induced monoarthritic rats (2 weeks) --- p.68 / Chapter 4.2.1 --- Method --- p.68 / Chapter 4.2.2 --- Results --- p.69 / Chapter 4.2.2.1 --- Body weight --- p.69 / Chapter 4.2.2.2 --- Knee joint sizes --- p.69 / Chapter 4.2.2.3 --- Knee extension angles --- p.69 / Chapter 4.2.2.4 --- Knee joint blood flow --- p.70 / Chapter 4.2.2.5 --- Histological evaluation --- p.70 / Chapter 4.2.2.5.1 --- Cell infiltration --- p.70 / Chapter 4.2.2.5.2 --- Synovial tissue proliferation --- p.71 / Chapter 4.2.2.5.3 --- Cartilage degradation --- p.71 / Chapter 4.3 --- Discussions --- p.78 / Chapter Chapter 5 --- Effects of intra-articular injection of LS in adjuvant-induced monoarthritic rats --- p.82 / Chapter 5.1 --- Method --- p.82 / Chapter 5.2 --- Results --- p.83 / Chapter 5.2.1 --- Body weight --- p.83 / Chapter 5.2.2 --- Knee joint sizes --- p.83 / Chapter 5.2.3 --- Knee extension angles --- p.85 / Chapter 5.2.4 --- Knee joint blood flow --- p.87 / Chapter 5.3 --- Discussions --- p.98 / Chapter Chapter 6 --- Effects of oral administration of LS in adjuvant-induced monoarthritic rats --- p.102 / Chapter 6.1 --- Oral administration of LS for 6 days after induction of arthritis --- p.102 / Chapter 6.1.1 --- Method --- p.102 / Chapter 6.1.2 --- Results --- p.103 / Chapter 6.1.2.1 --- Body weight --- p.103 / Chapter 6.1.2.2 --- Knee joint sizes --- p.103 / Chapter 6.1.2.3 --- Knee extension angles --- p.105 / Chapter 6.1.2.4 --- Knee joint blood flow --- p.106 / Chapter 6.1.2.5 --- Histological evaluation --- p.107 / Chapter 6.1.2.5.1 --- Cell infiltration --- p.107 / Chapter 6.1.2.5.2 --- Synovial tissue proliferation --- p.107 / Chapter 6.1.2.5.3 --- Cartilage degradation --- p.108 / Chapter 6.2 --- Oral administration of LS for 7 days before and 7 days after induction of arthritis --- p.131 / Chapter 6.2.1 --- Method --- p.131 / Chapter 6.2.2 --- Results --- p.132 / Chapter 6.2.2.1 --- Body weight --- p.132 / Chapter 6.2.2.2 --- Knee joint sizes --- p.132 / Chapter 6.2.2.3 --- Knee extension angles --- p.134 / Chapter 6.2.2.4 --- Knee joint blood flow --- p.137 / Chapter 6.2.2.5 --- Histological evaluation --- p.137 / Chapter 6.2.2.5.1 --- Cell infiltration --- p.137 / Chapter 6.2.2.5.2 --- Synovial tissue proliferation --- p.138 / Chapter 6.2.2.5.3 --- Cartilage degradation --- p.138 / Chapter 6.3 --- Oral administration of LS for 13 days after induction of arthritis --- p.165 / Chapter 6.3.1 --- Method --- p.165 / Chapter 6.3.2 --- Results --- p.166 / Chapter 6.3.2.1 --- Body weight --- p.166 / Chapter 6.3.2.2 --- Knee joint sizes --- p.166 / Chapter 6.3.2.3 --- Knee extension angles --- p.168 / Chapter 6.3.2.4 --- Knee joint blood flow --- p.169 / Chapter 6.3.2.5 --- Histological evaluation --- p.170 / Chapter 6.3.2.5.1 --- Cell infiltration --- p.170 / Chapter 6.3.2.5.2 --- Synovial tissue proliferation --- p.170 / Chapter 6.3.2.5.3 --- Cartilage degradation --- p.171 / Chapter 6.4 --- Discussions --- p.194 / Chapter Chapter 7 --- Effects of intra-peritoneal administration of LS in adjuvant-induced monoarthritic rats --- p.203 / Chapter 7.1 --- Method --- p.203 / Chapter 7.2 --- Results --- p.204 / Chapter 7.2.1 --- Body weight --- p.204 / Chapter 7.2.2 --- Knee joint sizes --- p.205 / Chapter 7.2.3 --- Knee extension angles --- p.207 / Chapter 7.2.4 --- Knee joint blood flow --- p.209 / Chapter 7.2.5 --- Histological evaulation --- p.209 / Chapter 7.2.5.1 --- Cell infiltration --- p.209 / Chapter 7.2.5.2 --- Synovial tissue proliferation --- p.210 / Chapter 7.2.5.3 --- Cartilage degradation --- p.210 / Chapter 7.3 --- Discussions --- p.237 / Chapter Chapter 8 --- Conclusions --- p.239 / References --- p.243