A personalized approach to insomnia treatment in patients with chronic back pain
https://doi.org/10.21518/2079-701X-2022-16-21-120-126
Abstract
Sleep disorders and back pain are often found in the practice of various doctors specialties. Often these two conditions are comorbid. Sleep disorders can be both acute and chronic. To verify the state of insomnia, diagnostic criteria (MKRS-3) are proposed. Sleep disorder therapy is a complex task and includesnon-drug approaches (sleep hygiene, psychotherapeutic techniques, etc.) with more lasting effect. Drug therapy is considered as additional method of treatment using several groups of drugs. Doxylamine H1-receptor antagonists, is one of the well-known and promising drugs. The article describes two clinical cases of patients with back pain and concomitant sleep disorders. To relieve pain in both cases, standard therapy was prescribed, including NSAIDs, a muscle relaxants, B vitamins, and physiotherapy exercises. In order to normalize night sleep, the Doxylamine was additionally in a standard dosage. However, the second patient developed morning sleepiness while taking the standard dose, which required a dose reduction. Taking Doxylamine at a lower dosage effectively stopped sleep disorders and did not cause the development of drowsiness and lethargy.
About the Authors
F. I. DevlikamovaRussian Federation
Farida I. Devlikamova, Dr. Sci. (Med.), Professor of the Department of Neurology
11, Mushtari St., Kazan, 420012
D. H. Khaibullina
Russian Federation
Dina H. Khaibullina, Cand. Sci. (Med.), Associate Professor of the Department of Neurology
11, Mushtari St., Kazan, 420012
References
1. Vos T., Barber R.M., Bertozzi-Villa A., Bell B. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. https://doi.org/10.1016/s0140-6736(15)60692-4.
2. Qaseem A., Wilt T.J., McLean R.M., Forciea M.A. Noninvasive Treatmentsfor Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American Collegeof Physicians. Ann Intern Med. 2017;166(7):514–530. https://doi.org/10.7326/m16-2367.
3. Парфенов В.А., Исайкин А.И. Боли в поясничной области. М.; 2018. 200 с. Режим доступа: https://static-ru.insales.ru/files/1/8037/5726053/original/boli_v_pojasn_oblasti.pdf. Parfenov V.A., Isaikin A.I. Pain in the lumbar region. Moscow; 2018. 200 p. (In Russ.) Available at: https://static-ru.insales.ru/files/1/8037/5726053/original/boli_v_pojasn_oblasti.pdf.
4. Парфенов В.А., Ламкова И.А. Хроническая скелетно-мышечная поясничная боль: коморбидные нарушения и терапия. Медицинский совет. 2021;(10):34–41. https://doi.org/10.21518/2079-701X-2021-10-34-41. Parfenov V.A., Lamkova I.A. Chronic musculoskeletal low back pain: comorbid disorders and therapy. Meditsinskiy Sovet. 2021;(10):34–41. (In Russ.) https://doi.org/10.21518/2079-701X-2021-10-34-41.
5. Mathias J.L., Cant M.L., Burke A.L.J. Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis. Sleep Med. 2018;(52):198–210. https://doi.org/10.1016/j.sleep.2018.05.023.
6. Lichstein K.L., Taylor D.J., McCrae C.S., Petrov M.E. Insomnia: epidemiology and risk factors. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia: Elsevier; 2016, pp. 761–768. https://doi.org/10.1016/B978-1-4160-6645-3.00076-1.
7. Курушина О.В., Барулин А.Е., Багирова Д.Я. Современные подходы к лечению инсомнии в общетерапевтической практике. Медицинский совет. 2019;(6):20–26. https://doi.org/10.21518/2079-701X-2019-6-20-26. Kurushina O.V., Barulin A.E., Bagirova D.Y. Modern approaches to the management of insomnia in general therapeutic practice. Meditsinskiy Sovet. 2019;(6):20–26. (In Russ.) https://doi.org/10.21518/2079-701X-2019-6-20-26.
8. Thorpy M.J., Broughton R.J., Cohn M.A., Czeisler C.A., Dement W.C., Ferber R. et al. The International classification of sleep disorders (Diagnostic and coding manual). American Academy of Sleep Medicine. U.S.A.: Darien; 2014. Available at: ICSD international classification of sleep disorders. pdf (onlinesleepclinic.co.uk).
9. Baldwin C.M., Ervin A.M., Mays M.Z., Robbins J., Shafazand S. et al. Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study. J Clin Sleep Med. 2010;6(2):176–183. Available at: Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study - PubMed (nih.gov).
10. Thase M.E. Treatment issues related to sleep and depression. J Clin Psychiatry. 2000;61(11):46–50. Available at: Treatment issues related to sleep and depression - PubMed (nih.gov).
11. Дубницкая Э.Б. Атипичные депрессии и гипомании. В: Смулевич А.Б. (ред.) Пограничная психическая патология в общемедицинской практике. М.: Русский врач; 2000. С. 15–17. Режим доступа: https://megaobuchalka.ru/8/2491.html?ysclid=lah3lk16t1749087342. Dubnitskaya E.B. Types of atypical depression and hypomania. In: Smulevich A.B. (eds). Borderline personality disorder in general medical practice. Moscow: Russkiy vrach; 2000, pp. 15–17. (In Russ.) Available at: https://megaobuchalka.ru/8/2491.html?ysclid=lah3lk16t1749087342.
12. Fernandez-Mendoza J., Vgontzas A.N., Liao D., Shaffer M.L., Vela-Bueno A., Basta M., Bixler E.O. Insomnia with objective short sleep duration and incident hypertension: the Penn State Cohort. Hypertension. 2012;60(4):929–935. https://doi.org/10.1161/HYPERTENSIONAHA.112.193268.
13. Bathgate C.J., Edinger J.D., Wyatt J.K., Krystal A.D. Objective but not subjective short sleep duration associated with increased risk for hypertension in individuals with insomnia. Sleep. 2016;39(5):1037–1045. https://doi.org/10.5665/sleep.5748.
14. Engstrøm M., Hagen K., Bjørk M.H., Stovner L.J., Sand T. Sleep quality and arousal in migraine and tension-type headache: the headache-sleep study. Acta Neurol Scand Suppl. 2014;(198):47–54. https://doi.org/10.1111/ane.12237.
15. Kikuchi H., Yoshiuchi K., Yamamoto Y., Komaki G., Akabayashi A. Does sleep aggravate tension-type headache? An investigation using computerized ecological momentary assessment and actigraphy. Biopsychosoc Med. 2011;(5):10. https://doi.org/10.1186/1751-0759-5-10.
16. Mork P.J., Nilsen T.I. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012;64(1):281–284. https://doi.org/10.1002/art.33346.
17. Aili K., Nyman T., Svartengren M., Hillert L. Sleep as a predictive factor for the onset and resolution of multi-site pain: a 5-year prospective study. Eur J Pain. 2015;19(3):341–349. https://doi.org/10.1002/ejp.552.
18. Bonvanie I.J., Oldehinkel A.J., Rosmalen J.G., Janssens K.A. Sleep problems and pain: a longitudinal cohort study in emerging adults. Pain. 2016;157(4):957–963. https://doi.org/10.1097/j.pain.0000000000000466.
19. Koffel E., Kroenke K., Bair M.J., Leverty D., Polusny M.A., Krebs E.E. The bidirectional relationship between sleep complaints and pain: Analysis of data from a randomized trial. Health Psychol. 2016;35(1):41–49. https://doi.org/10.1037/hea0000245.
20. Kikuchi H., Yoshiuchi K., Yamamoto Y., Komaki G., Akabayasha A. Does sleep aggravate tension-type headache? An investigation using computerized ecological momentary assessment and actigraphy. Biopsychosoc Med. 2011;(5):10. https://doi.org/10.1186/1751-0759-5-10.
21. Дубинина Т.В., Елисеев М.С. Боль в нижней части спины: распространенность, причины, диагностика, лечение. Неврология, нейропсихиатрия, психосоматика. 2011;(1):22–26. https://doi.org/10.14412/2074-2711-2011-129. Dubinina T.V., Eliseyev M.S. Low back pain: prevalence, causes, diagnosis, treatment. Neurology, Neuropsychiatry, Psychosomatics. 2011;(1):22–26. (In Russ.) https://doi.org/10.14412/2074-2711-2011-129.
22. Парфенов В.А., Головачева В.А. Диагностика и лечение острой неспецифической пояснично-крестцовой боли. Терапевтический архив. 2019;91(8):155–159. https://doi.org/10.26442/00403660.2019.08.000315. Parfenov V.A., Golovacheva V.A. Diagnosis and treatment of acute low back pain. Terapevticheskii Arkhiv. 2019;91(8):155–159. (In Russ.) https://doi.org/10.26442/00403660.2019.08.000315.
23. Mathias J.L., Cant M.L., Burke A.L.J. Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis. Sleep Med. 2018;(52):198–210. https://doi.org/10.1016/j.sleep.2018.05.023.
24. Виноградов Д.К., Доронина О.Б. Особенности нарушений сна у пациентов с хронической болью в спине. Клиническая практика. 2019;10(2):46–52. https://doi.org/10.17816/clinpract10246-52. Vinogradov D.K., Doronina O.B. Characteristics of Sleep Disorders in Patients with Chronic Back Pain. Journal of Clinical Practice. 2019;10(2):46–52. https://doi.org/10.17816/clinpract10246-52.
25. Bigatti S.M., Hernandez A.M., Cronan T.A., Rand K.L. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008;59(7):961–967. https://doi.org/10.1002/art.23828.
26. Campbell P., Tang N., McBeth J., Lewis M., Main C.J., Croft P.R. et al. The role of sleep problems in the development of depression in those with persistent pain: a prospective cohort study. Sleep. 2013;36(11):1693–1698. https://doi.org/10.5665/sleep.3130.
27. de Tommaso M., Delussi M., Vecchio E., Sciruicchio V., Invitto S., Livrea P. Sleep features and central sensitization symptoms in primary headache patients. J Headache Pain. 2014;15(1):64. https://doi.org/10.1186/1129-2377-15-64.
28. Nascimento D.C., Andersen M.I., Hapolide D.C., NobregaN. J., Tufik S. Pain hypersensitivity induced by paradoxical sleep deprivation is not due to altered binding to brain mu-opioid receptors. Behav Brain Res. 2007;178(2):216–220. https://doi.org/10.1016/j.bbr.2006.12.016.
29. Affleck G., Urrows S., Tennen H., Higgins P., Abeles M. Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain. 1996;68(2–3):633–668. https://doi.org/10.1016/s0304-3959(96)03226-5.
30. Atkinson J.H., Ancoli-Israel S., Slater M.A., Garfin S.R., Gillin C. Subjective sleep disturbance in chronic back pain. Clin J Pain. 1998;4(4):225–232. https://doi.org/10.1097/00002508-198812000-00007.
31. Bonvanie I.J., Oldehinkel A.J., Rosmalen J.G., Janssens K.A. Sleep problems and pain: a longitudinal cohort study in emerging adults. Pain. 2016;157(4):957–963. https://doi.org/10.1097/j.pain.0000000000000466.
32. Okura K., Lavigne G.J., Huynh N., Manzini C., Fillipini D., Montplaisir J.Y. Comparison of sleep variables between chronic widespread musculoskeletal pain, insomnia, periodic leg movements syndrome and control subjects in a clinical sleep medicine practice. Sleep Med. 2008;9(4):352–361. https://doi.org/10.1016/j.sleep.2007.07.007.
33. Drewes A., Arendt-Nielsen L. Pain and sleep in medical diseases: interactions and treatment possibilities. Sleep Res Online. 2001;4(2):67–76. Available at: https://www.researchgate.net/publication/279564160.
34. Ковальзон В.М., Стрыгин К.Н. Нейрохимические механизмы регуляции сна и бодрствования: роль блокаторов гистаминовых рецепторов в лечении инсомнии. Эффективная фармакотерапия. 2013;(12):8–14. Режим доступа: https://umedp.ru/articles/neyrokhimicheskie_mekhanizmy_regulyatsii_sna_i_bodrstvovaniya_rol_blokatorov_gistaminovykh_retseptor.html. Kovalzon V.M., Strygin K.N. Neurochemical mechanisms of sleep-wake regulation: the role of histamine receptors blockers in the treatment of insomnia. Effective Pharmacotherapy. 2013;(12):8–14. (In Russ.) Available at: https://umedp.ru/articles/neyrokhimicheskie_mekhanizmy_regulyatsii_sna_i_bodrstvovaniya_rol_blokatorov_gistaminovykh_retseptor.html.
35. Бабак С.Л., Голубев Л.А., Горбунова М.В. Хроническая инсомния в клинической практике терапевта. РМЖ. 2008;16(5):259–266. Режим доступа: https://www.rmj.ru/articles/nevrologiya/Hronicheskaya_insomniya_v_klinicheskoy_praktike_terapevta/. Babak S.L., Golubev L.A., Gorbunova M.V. Chronic insomnia in the clinical practice of the therapist. RMJ. 2008;16(5):259–266. (In Russ.) Available at: https://www.rmj.ru/articles/nevrologiya/Hronicheskaya_insomniya_v_klinicheskoy_praktike_terapevta/.
36. Оковитый С.В., Титович И.А. Фармакологические принципы терапии инсомнии. Медицинский совет. 2018;(6):26–32. https://doi.org/10.21518/2079-701X-2018-6-26-32. Okovityi S.V., Titovich I.A. Pharmacotherapy treatment principles for insomnia. Meditsinskiy Sovet. 2018;(6):26–32. (In Russ.) https://doi.org/10.21518/2079-701X-2018-6-26-32.
37. Левин Я.И. Сон, инсомния, доксиламин (Донормил). РМЖ. 2007;15(10):850–855. Режим доступа: https://www.rmj.ru/articles/nevrologiya/Son_insomniya_doksilamin_Donormil/. Levin Y.I. Sleep, insomnia, doxylamine (Donormil). RMJ. 2007;15(10):850-855. (In Russ.) Available at: https://www.rmj.ru/articles/nevrologiya/Son_insomniya_doksilamin_Donormil/.
38. Bakker R.A., Nicholas M.W., Smith T.T., Burstein E.S., Hacksell U., Timmerman H. et al. In vitro pharmacology of clinically used central nervous system-active drugs as inverse H(1) receptor agonists. J Pharmacol Exp Ther. 2007;322(1):172–179. https://doi.org/10.1124/jpet.106.118869.
39. Бурчаков Д.И., Тардов М.В. Инсомния в практике терапевта: роль доксиламина. Медицинский совет. 2020;(2):45–53. https://doi.org/10.21518/2079-701X-2020-2-45-53. Burchakov D.I., Tardov M.V. Insomnia in general practice: the role of doxylamine. Meditsinskiy Sovet. 2020;(2):45–53. (In Russ.) https://doi.org/10.21518/2079-701X-2020-2-45-53.
40. Шавловская О.А. Применение препарата Донормил (доксиламин) в клинической практике. РМЖ. 2011;(30):1877–1883. Режим доступа: https://www.rmj.ru/articles/nevrologiya/Primenenie_preparata_Donormil_doksilamin_v_klinicheskoy_praktike/. Shavlovskaya O.A. The use of the drug Donormil (doxylamine) in clinical practice. RMJ. 2011;(30):1877–1883. (In Russ.) Available at: https://www.rmj.ru/articles/nevrologiya/Primenenie_preparata_Donormil_doksilamin_v_klinicheskoy_praktike/.
41. Ковальзон В.М., Стрыгин К.Н. Нейрохимические механизмы регуляции сна и бодрствования: роль блокаторов гистаминовых рецепторов в лечении инсомнии. Эффективная фармакотерапия. 2013;(12):8–14. Режим доступа: https://umedp.ru/articles/neyrokhimicheskie_mekhanizmy_regulyatsii_sna_i_bodrstvovaniya_rol_blokatorov_gistaminovykh_retseptor.html?ysclid=l91a80d0d9. Kovalzon V.M., Strygin K.N. Neurochemical mechanisms of sleep-wake regulation: the role of histamine receptors blockers in the treatment of insomnia. Effective Pharmacotherapy. 2013;(12):8–14. (In Russ.) Available at: https://umedp.ru/articles/neyrokhimicheskie_mekhanizmy_regulyatsii_sna_i_bodrstvovaniya_rol_blokatorov_gistaminovykh_retseptor.html?ysclid=l91a80d0d9.
Review
For citations:
Devlikamova FI, Khaibullina DH. A personalized approach to insomnia treatment in patients with chronic back pain. Meditsinskiy sovet = Medical Council. 2022;(21):120-126. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-21-120-126