Aims: Sleep and pain share a complex relationship; pain can disrupt sleep and conversely, poor sleep can exaggerate pain intensity. At present, the exact temporal assoications sunderlying this relationship are not fully understood. Correlational data and preliminary experimental studies suggest that poor sleep augments pain in both acute and chronic situations. This thesis examines the reciprocal interaction between these two processes and the subsequent impact that sleep has on pain, at both the behavioural and brain level. Furthermore, the influence of co-morbid factors such as attention and affective state is considered. Developing an understanding of how sleep affects pain and pain-related attention may have implications for the treatment of chronic pain and its concomitants. Methods: A number of different settings were used to explore the relationship shared by sleep and pain. Epidemiological data was used to explore the association between sleep problems and the later development of musculoskeletal pain. The association between comorbid sleep and pain problems and pain-related complaints were also assessed in adolescent and adult clinical samples. An acute experimental model was used to explore the influence of non-stage-specific sleep disruption on pain and pain-related attention. The aim of this experiment was to explore the effects of sleep disruption on pain sensitivities, central pain modulation and distraction analgesia. Functional magnetic resonance imaging was used to investigate the effect of sleep disturbance on the cerebral signature of pain. Results: Data from a large birth cohort indicated that sleep problems were associated with the later development of musculoskeletal pain. Co-morbid sleep and pain problems were associated with a higher incidence of pain-related and psychological complaints in both adolescent and adult samples. The experimental disturbance of sleep resulted in mechanical and thermal hyperalgesia. Sleep disruption was also found to compromise both conditioned pain modulation and the analgesic benefits of distraction analgesia. Imaging data suggested that sleep disturbance was associated with regional changes in activation in areas previously implicated in pain processing. Neural decoupling was also observed across regions of the cortex and brainstem, the implications of which could be critical for understanding pain processing following sleep disturbance. Conclusions: Results from this thesis suggest that sleep disturbance is an important risk factor in both the development and maintenance of clu'onic pain. The effects of sleep disturbance on both central pain modulation and distraction analgesia are possible pathways by which sleep disturbance facilitates vulnerability for the development of clu'onic pain. Sleep disturbance is reported by two thirds of chronic pain patients and should therefore be identified as a key modifiable target in the treatment of chronic pain. Further explorations of the relationship shared by sleep and pain, in addition to their related concomitants (e.g., mood disturbance) can help establish novel targets which can be manipUlated for diagnostic and therapeutic gain.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:689675 |
| Date | January 2015 |
| Creators | Harrison, Lee |
| Publisher | University of Bristol |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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