Osteoarthritis (OA) is one of the most common diseases and leading causes of disability in the world. Sleep disturbance, in addition to pain, is one of more frequent and disabling symptoms of OA. Numerous longitudinal and some experimental studies indicate that while poor sleep is a consequence of pain, sleep disturbance may also reciprocally feedback to cause hyperalgesia and exacerbate clinical pain. Recent conceptual models of chronic pain, including OA pain, implicate dysfunctional supraspinal pain processing mechanisms that modulate (amplify or inhibit) nociceptive transmission. Preliminary work by our group indicates that clinically relevant sleep disruptions directly impair these central pain processing mechanisms in healthy individuals. Empirical treatments for sleep disturbance in OA are lacking, as are data indicating whether normalization of sleep alters pain processing mechanisms and clinical pain. This proposal seeks to extend our work to investigate neurobehavioral causes and treatments of clinical pain in knee OA. Project aims are to: 1) determine the extent to which sleep maintenance insomnia and objective polysomnographic measures of sleep are associated with alterations in pain modulation and 2) evaluate whether improving sleep disturbance decreases clinical pain by improving pain modulation. Two inter-related studies are proposed. Study 1 is a factorial comparison of knee OA patients with and without insomnia versus matched controls with and without insomnia. These 4 groups will be compared on electroencephalographic measures of sleep, laboratory indices of pain modulation, and clinical pain ratings. Study 2 is a randomized, double-blinded, placebo controlled clinical trial of cognitive-behavior therapy for insomnia (CBT-I) in knee OA. Subjects from Study 1, meeting criteria for sleep maintenance insomnia will be randomized to a validated CBT-I protocol or a standardized behavioral placebo control. Primary endpoints measured half-way through treatment (4 weeks), at post-treatment, and 3 and 6 month follow-ups are: objective and subjective measures of sleep, laboratory measures of pain modulation, and clinical pain severity. This project will increase knowledge of the mechanisms by which sleep disturbance enhances pain sensitivity and lead to a critically needed empirical, non-pharmacological treatment approach for insomnia in OA. Osteoarthritis impacts approximately 29% of adults over the age of 44 and 50% of adults over the age of 64. Pain and insomnia are two of the most common and disabling symptoms associated with degenerative joint disease that cause substantial personal suffering and pose considerable burden on the healthcare system and the economy. This project will: 1) increase the scientific understanding of the mechanisms by which chronic sleep disturbance amplifies pain in arthritis and 2) rigorously test whether a much needed behavioral treatment for insomnia in arthritis not only improves sleep, but in turn reduces pain. ? ? ?

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Biobehavioral Mechanisms of Emotion, Stress and Health Study Section (MESH)
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Lester, Gayle E
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Johns Hopkins University
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United States
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Speed, Traci J; Richards, Jessica M; Finan, Patrick H et al. (2017) Sex moderates the effects of positive and negative affect on clinical pain in patients with knee osteoarthritis. Scand J Pain 16:66-73
Lerman, Sheera F; Finan, Patrick H; Smith, Michael T et al. (2017) Psychological interventions that target sleep reduce pain catastrophizing in knee osteoarthritis. Pain 158:2189-2195
Salwen, Jessica K; Smith, Michael T; Finan, Patrick H (2017) Mid-Treatment Sleep Duration Predicts Clinically Significant Knee Osteoarthritis Pain reduction at 6 months: Effects From a Behavioral Sleep Medicine Clinical Trial. Sleep 40:
Wideman, Timothy H; Edwards, Robert R; Finan, Patrick H et al. (2016) Comparing the Predictive Value of Task Performance and Task-Specific Sensitivity During Physical Function Testing Among People With Knee Osteoarthritis. J Orthop Sports Phys Ther 46:346-56
Spira, Adam P; Runko, Virginia T; Finan, Patrick H et al. (2015) Circadian rest/activity rhythms in knee osteoarthritis with insomnia: a study of osteoarthritis patients and pain-free controls with insomnia or normal sleep. Chronobiol Int 32:242-7
Quartana, Phillip J; Finan, Patrick H; Smith, Michael T (2015) Evidence for Sustained Mechanical Pain Sensitization in Women With Chronic Temporomandibular Disorder Versus Healthy Female Participants. J Pain 16:1127-35
Quartana, Phillip J; Finan, Patrick H; Page, Gayle G et al. (2015) Effects of insomnia disorder and knee osteoarthritis on resting and pain-evoked inflammatory markers. Brain Behav Immun 47:228-37
Campbell, Claudia M; Buenaver, Luis F; Finan, Patrick et al. (2015) Sleep, Pain Catastrophizing, and Central Sensitization in Knee Osteoarthritis Patients With and Without Insomnia. Arthritis Care Res (Hoboken) 67:1387-96
Smith, Michael T; Finan, Patrick H; Buenaver, Luis F et al. (2015) Cognitive-behavioral therapy for insomnia in knee osteoarthritis: a randomized, double-blind, active placebo-controlled clinical trial. Arthritis Rheumatol 67:1221-33
Finan, Patrick H; Buenaver, Luis F; Coryell, Virginia T et al. (2014) Cognitive-Behavioral Therapy for Comorbid Insomnia and Chronic Pain. Sleep Med Clin 9:261-274

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