Lifestyle

Objectives

  • Understand the influence of sleep hygene on pain
  • Understand the influence of smoking on general health and surgical risks
  • Understand the influence of psychological factors (mood, depression) on pain, and when to refer

General principles of lifestyle and OA:

  • People should be encouraged via a behaviour change approach to adopt healthy lifestyle-including physical activity recommendations, smoking cessation, alcohol restriction, good nutrition and sleep hygiene
  • All people with OA should be encouraged to as a minimum maintain general physical activity levels, if possible increase physical activity levels-see physical activity compoent for more details
  • Management of persistent pain requires strategies that address likely multiple contributors to pain experience, including psychological factors

 

Importance of sleep hygiene

Insomnia is associated with greater pain intensity; and with the OA population at risk of other comorbidities such as obesity and asthma, there is potential also for sleep apnoea (Smith et al., 2009).

Proposed model of cycle of disturbed sleep contributing to increased central pain processing, exacerbating pain, making sleep more difficult

Insomnia also associated with depression and poorer physical functioning (Ho et al., 2019), interventions including CBT and pharmacy helped to improve sleep but no effect on pain in recent systematic review.

More severe radiological knee changes associated with increased nocturnal knee pain and disturbed quality of sleep (Sasaki et al., 2014)

Sleep disturbance is linked with depression and disability in OA; with depression linked to pain (Parmelee et al., 2015)

Insomnia can effect pain catastrophizing and hypervigilience; therefore important to address poor sleep

Consider referral to GP or pharmacist if identify insomnia .

See other resources section for information on improving general sleep hygiene

 

 

Correlation between imaging findings and pain severity is poor- half people with knee radiographic changes have pain, and 30-50% of older adults with knee pain do not have radiographic changes; although association between x-ray findings and pain is higher with more severe radiological changes (Bedson & Croft, 2008).

Therefore suggests other factors contribute to pain, including state of mind and distress and pain neurophysiology-it is complicated! Pain is a an emotional experience, and invovles both peripheral and central nervous system, with psycho-social factors influencing these .

One in six patients with OA report high or very psychological distress which can “turn up the volume” on pain

Self efficacy and pain refers to a person’s ability to cope and self manage around a pain experience.

Self efficacy is associated with coping behaviors and beliefs regarding controllability of pain’ (Kittelson et al., 2014).

Can teach pain coping skills, with increased self-efficacy; evidence of improved pain and better functional outcomes with high levels of self efficacy and successful self management strategies (Lorig et al., 2008)

People with poor self-efficacy and high pain catastrophising tend to have more severe pain and clinical outcomes not as good

EQ5D has section on anxiety and depression, important to ask people about this and form can be a good lead in, e.g. ‘I see on the form you ticked extreme for anxiety/depression, how is your mood at the moment’, are they seeing someone currently for support

Psychological support

Some community health services offer counselling and/or psychologists

May be eligible for Mental Health Care Plan
-Up to 10 individual and 10 group sessions subsidised by Medicare; arranged via GP.
-Need a re-assessment with GP after 6 visits.
-Can include psychologist, social worker, occupational therapist, counsellor.
-Can also include online sessions if eligible due to rural/remote setting

Psychological factors:

Several guidelines recommend assessing psycho-social factors (EULAR, NICE, MOVE)-can consider using screening tools such as STarT MSK or Orebro Musculoskeletal Screening tools

Beliefs about pain and fear avoidance

Psychological therapies may be required for help with distress, depression, anxiety or other mental health issues

Cognitive behavioural therapy (CBT) strategies for persistent pain maybe required, as well as other potential strategies including graded physical activity and could be accessed either through local primary care (e.g. community health physiotherapists) or specialised pain services .

CBT can improve outcomes including pain severity, pain catastrophizing, depression, anxiety and sleep disturbance.

 

See other resources section for more options

This way up: online modules for patient to complete as well as health professionals, includes information on Cognitive Behaviour Therapy; use to help with sadness, worry, obsessions and compulsions, panic and shyness (affiliated with St Vincent’s Hospital Sydney)

My joint pain (courtesy of Arthritis Australia):

Online tool for patients and health professionals   myjointpain.org
Section on nutrition
Section on awareness of thoughts and emotions

Beyond Blue handout on chronic physical illness, anxiety and depression (see website https://www.beyondblue.org.au/)

Website with links to various modules from Curtain University in WA regarding pain and pain management: painhealth.csse.uwa.edu.au/

Youtube presentation for patients on pain from Dr Lorimer Moseley ‘Tame the Beast’
and website (includes some links and resources) https://www.tamethebeast.org/

MindSpot: https://mindspot.org.au/ funded by health direct and the Australian Government, website with information on anxiety, depression and chronic pain; includes online assessment  and requires patients to create an account for this. Then complete assessment, either online or over phone. MindSpot therapist creates report and phone call suggests treatment options-including free online courses or posted materials. Not suitable for very severe depression or other very severe symptoms

Sleep:

Healthy sleep habits

Better health Victoria handout for sleep hygiene

Smoking cessation-quit website

Effects of smoking on body online tool can show patients