MedicalResearch.com Interview with: Nicole Tang, D.Phil, C.Psychol (Reader) Department of Psychology Warwick Sleep and Pain Lab University of Warwick MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current guidelines recommend non-opioid therapy as the preferred treatment of chronic non-malignant (CNP) pain, with opioids reserved to situations “when benefits for pain and function are expected to outweigh risks” [1,10]. Whilst the effectiveness of opioid therapy is usually measured in terms of pain outcomes, less is known about its effect on day-to-day functions. A particular function of concern to patients with chronic non-malignant pain is the ability to get a good night's sleep. The current systematic review has identified a set of papers with relevant outcomes regarding the effect of opioid therapy on sleep quality and sleep architecture in CNP patients. It extends our understanding from the drug's respiratory depression effect in healthy individuals to the potential risks and utility of opioid therapy for chronic non-malignant pain patients with sleep disturbances. Whilst the narrative synthesis and the exploratory meta-analysis of a subset of data both suggest that the use of opioid therapy is associated with an overall report of sleep quality improvement, such an improvement is not consistently replicated across studies or substantiated by improvements in sleep parameters linked to deeper and better-sleep quality. Moreover, the improvement may be accompanied by undesirable side effects and increased daytime sleepiness that contradict with the very idea of improved sleep quality. We are also painfully aware of the methodological limitations of the studies reviewed; their exposure to different sources of biases has heightened the risk of result inflation. To many patients with chronic non-malignant pain, improved sleep is a top priority when evaluating the performance of a new drug and non-drug intervention. If we were to advance our current understanding of the opioid-sleep relationship, future trials need to be designed with this interdisciplinary question in mind such that validated measures of sleep can be incorporated as an outcome measure alongside pain. (more…)