Why Pain Management Plans are Failing those in Middle Age

Why Solving This Overlooked Factor Could Alleviate Your Pain

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My Longevity Experiment
November 30, 2024

Improving Sleep and Physical Activity Reduces Pain in Osteoarthritis Patients

Osteoarthritis (OA) is a debilitating condition affecting more than 32 million Americans and over 28% of individuals aged 60 and older globally. The condition manifests as joint pain and stiffness, which can significantly impair mobility and quality of life. Globally, OA impacts an estimated 10% of men and 18% of women over 60, presenting a pressing public health challenge.

Exercise as a Commonly Recommended Treatment

For those living with OA, physical activity is often prescribed as a way to manage pain and maintain mobility. However, many individuals with OA struggle to adopt or sustain an exercise routine due to the pain associated with movement. This pain creates a barrier to staying active and can result in a cycle of pain, inactivity, and further physical decline.

Daniel Whibley, PhD, Assistant Professor of Physical Medicine and Rehabilitation at the University of Michigan, emphasized the challenges faced by this population: "Pain during movement is an important reason why this population isn't more active, and we need to identify ways we can help to change this. Otherwise, they may end up in a loop of pain and inactivity that we know can lead to disability later down the line."

The Role of Sleep in Pain and Physical Activity

Research increasingly highlights the critical relationship between sleep and pain management in OA. High-quality sleep for an appropriate duration has been shown to alleviate OA-related discomfort and support physical activity.

"If you're sleeping well, you're more likely to be able to move more the next day or stick with a planned exercise program. And those who are physically active during the day are more likely to get a good night's sleep,” said Professor Whibley. He further noted that many existing exercise programs for OA pay insufficient attention to sleep health, despite its impact on pain and activity levels.

Cognitive-behavioral therapy for insomnia (CBT-I) has also gained attention as a potential tool for improving both sleep quality and OA pain. According to Whibley, CBT-I offers promise by addressing problematic thought patterns and behaviors that disrupt sleep.

A New Hybrid Approach: Sleep and Exercise

Professor Whibley and his research team sought to explore the interplay between sleep and physical activity in pain management through the development of a hybrid intervention. This novel program combines a digital sleep therapy tool with a structured exercise regimen.

The sleep component, an automated program called Sleepio, delivers internet-based CBT-I, along with education and behavior modifications for improving sleep routines. In parallel, participants engage in a six-week exercise program with remote weekly support from a coach.

Involving Patients in Program Development

The researchers engaged focus groups of individuals living with OA-related pain and sleep disturbances to shape the program’s design. These discussions informed the development of prototype materials and highlighted key factors that would encourage adherence to the intervention.

Motivational language, personal accountability, and access to educational resources emerged as critical elements for success. "The participants wanted to be encouraged to stick to the sleep and exercise components of the program using terms void of negative associations that made it seem like punishment. They also wanted to share records of activity with health care professionals without feeling like they have no power in the dynamic," Whibley explained.

Addressing Barriers to Engagement

Anna Kratz, PhD, co-investigator and Associate Professor of Physical Medicine and Rehabilitation at Michigan Medicine, noted the importance of understanding barriers to engagement. “Previous negative interactions with healthcare providers, such as feeling patronized or underestimated, and being asked to excessively record sleep and daily physical activity, may cause people to feel disinterested or discouraged.”

To overcome these barriers, the team created user-friendly intervention materials, including a workbook that allows participants to set personalized goals for sleep and activity. These tools are designed to empower individuals and promote adherence to the program.

Looking Ahead: Testing Feasibility

A small-scale feasibility test of the hybrid program is currently underway. Following this initial phase, the researchers plan to conduct a full-scale trial to further investigate the impact of combining sleep and physical activity interventions on OA-related pain.

Professor Whibley expressed optimism about the potential of the program: "People living with OA want to improve their sleep, physical activity and exercise behavior and reduce their pain—all of these are valued outcomes. I'm not saying this new program will be a magic bullet for everyone, but I think the hybrid approach holds great potential for the future of OA-related pain management."

This innovative approach to managing osteoarthritis could pave the way for more effective and holistic pain management strategies, improving the lives of millions worldwide.

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