ArticleArthritis care & research2023
Pain Sensitization as a Potential Mediator of the Relationship Between Sleep Disturbance and Subsequent Pain in Rheumatoid Arthritis.
Article in Arthritis care & research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 15 citations in OpenAlex.
- Decoding pain in axial spondyloarthritis: Mechanisms, management, and future directions.Best practice & research. Clinical rheumatology · 2026Review
- Sleep measurement and clinical impact in osteoarthritis and inflammatory arthritis: a scoping review.Rheumatology (Oxford, England) · 2026Article
- Review
- Observational
- Association Between Sleep Disturbance and Subsequent Pain Interference in Patients With Early Rheumatoid Arthritis.Arthritis care & research · 2025Article
- Central aspects of pain associated with physical activity: results from the Investigating Musculoskeletal Health and Wellbeing cohort.Pain reports · 2025Article
- Genetically predicted effects of 10 sleep phenotypes on revision of knee arthroplasty: a mendelian randomization study.Journal of orthopaedic surgery and research · 2024Article
- Characterization of sleep disturbance in established rheumatoid arthritis patients: exploring the relationship with central nervous system pain regulation.BMC rheumatology · 2024Article
- Elevated pain sensitivity is associated with reduced rapid eye movement (REM) sleep in females with comorbid temporomandibular disorder and insomnia.Pain medicine (Malden, Mass.) · 2024Article
- A Narrative Review of the Reciprocal Relationship Between Sleep Deprivation and Chronic Pain: The Role of Oxidative Stress.Journal of pain research · 2024Review
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Authors and funding
10 authors at 6 institutions in 1 country.
Funding
Abstract
objectiveMany patients with rheumatoid arthritis (RA) experience sleep disturbances, commonly attributed to joint pain. Sleep disturbances could also influence pain. One mechanism may be through dysregulated pain processing, manifested by enhanced pain sensitivity. The present study was undertaken to examine the role of pain sensitization, measured by quantitative sensory testing (QST), as a mediator in the pathway of sleep disturbance leading to subsequent pain.
methodsWe used longitudinal data from 221 patients with active RA who were followed for 12 weeks after initiating a disease-modifying antirheumatic drug. Baseline QST included pressure pain thresholds at articular (wrists, knees) and nonarticular (trapezius, thumbnails) sites, temporal summation (TS) at the wrist and forearm, and conditioned pain modulation (CPM). Baseline sleep disturbance and subsequent pain intensity were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS). We evaluated correlations between sleep disturbance, QSTs, and subsequent pain intensity. Mediation analyses separately assessed each QST as a mediator, adjusting for baseline confounding factors.
resultsSleep disturbance was correlated with all QST measures except wrist TS and CPM. Sleep disturbance significantly predicted subsequent pain (coefficient for a meaningful increase of 5 units in sleep disturbance = 0.32 (95% confidence interval 0.11, 0.50) in multiple regression. QST mediated 10-19% of this effect.
conclusionPain sensitization may be one mechanism through which sleep disturbance contributes to pain. The small magnitude of association indicates that unmeasured pathways may contribute to this relationship. Intervention studies are needed to establish causality and determine whether improving sleep can improve pain in patients with RA.
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