Background & Aims
Previous reports on the effects of medical opioid analgesics used for treating chronic pain have shown inconsistent results regarding their impact on sleep, as well as on physical and psychological stress. The aim of this study is to examine the quality of sleep and physical and psychological stress in patients with non-cancer chronic pain, comparing those who use opioid analgesics and those who do not, using wearable devices and a simple salivary amylase measuring instrument.
Methods
In a study at a pain clinic, 29 non-cancer chronic pain patients (12 women, 17 men; median age 66.9; pain duration 91 months) were observed. They were classified by opioid use: 11 non-users, 18 users (8 weak opioids, 5 strong opioids <60 mg morphine equivalent, 5 strong opioids ?60 mg morphine equivalent). Over seven days, their pre-sleep and waking salivary amylase levels were measured with a simple tool, and sleep was tracked using a wearable device. AI analyzed sleep-wake patterns such as total sleep time, sleep arousal, and sleep efficiency. On the first day, patients completed the numerical rating scale, Japanese Perceived Stress Scale (JPSS), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS). A generalized mixed model was used to compare salivary amylase and sleep quality across groups, taking non-users as a reference. The association between JPSS score and amylase levels was estimated using the same model.
Results
Compared to opioid non-users, high dose opioid users had higher pain intensity and were more depressive, but they did not have higher scores in JPSS, HADS anxiety score, or PCS score. Furthermore, compared to non-users, high dose users had higher amylase levels upon waking, and their sleep quality was lower, but there was no difference in the amylase levels at bedtime. Subjective stress measured by JPSS was associated with pre-sleep salivary amylase, but not with salivary amylase upon waking.
Conclusions
In cases of high-dose strong opioid use, there is an observed increase in the severity and depressive nature of pain, which may adversely affect sleep quality. Moreover, the association of high-dose strong opioid use with elevated salivary amylase levels upon waking (rather than before sleeping) suggests that these opioids are more likely impacting sleep quality rather than amplifying subjective stress experienced during the day.
References
?Martin D Cheatle, Lynn R Webster, et al. Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies. Pain Medicine. 2015; Volume 16, Issue suppl_1: S22–S26.
?Nicholas J Cutrufello, Vlad D Lanus, et al. Opoids snd Sleep. Current Opinion in Pulmonary Medicine. 2020; Volume 26, Issue 6: 634-641.
?Serdarevic M, Osborne V, et al. The association between insomnia and prescription opioid use: results from a community sample in Northeast Florid. Sleep Health. 2017; Volume 3, Issue 5: 368-372
?Michell Cao, Shahrokh Javaheri, et al. Effect of Chronic Opioid Use on Sleep and Wake. Sleep Medicine Clinics. 2018; Volume 13, Issue 2: 271-281