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A Vicious Cycle in Osteoarthritis: 

Sleep Disturbance-Pain
Depression-Disability

New research confirms that sleep disturbances are linked to pain and depression, but not disability, among patients with osteoarthritis (OA). Study results published in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR), found that poor sleep increases depression and disability, but does not worsen pain over time.

Arthritis is one of the top three health concerns that cause disability in the U.S., with OA being the most common form of arthritis. Medical evidence reports that nearly 30 million Americans are affected by OA, which has increased healthcare costs by $186 billion between 1996 and 2005. Previous studies show that those with knee OA report issues with initiating sleep (31%), difficulty maintaining sleep at night (81%), and general sleep problems (77%).

“Sleep disturbance is a common complaint among those with pain, particularly among those with OA,” explains Dr. Patricia Parmelee from the Center for Mental Health & Aging at The University of Alabama in Tuscaloosa. “Our research is unique as we investigate the complex relationships among sleep, OA-related pain, disability and depressed mood simultaneously in a single study.”

For the present study 288 patients with knee OA provided information on sleep disturbances, pain, functional limitations, and depressive symptoms. Researchers recruited participants from diverse settings to gather a broad representation of OA subjects. Sleep disturbances at the start of the study were used to predict changes in pain, disability and depression after a one-year period.

Findings indicate that sleep was independently associated with pain and depression at baseline. Disability was not linked to baseline sleep disturbances. In individuals with high pain levels, the combination of poor sleep and pain exacerbated depression. Sleep disturbance at baseline predicted increased depression and disability, but not pain at one-year follow-up.

Dr. Parmelee adds, “This study shows that depression plays a strong role in the sleep-pain connection, particularly with severe pain. Further investigation of sleep in disability progression may lead to new interventions that disrupt the cycle of OA distress.” (PR)


Open payments database launch
meets widespread skepticism

Several outlets continue their coverage of the release of data aimed at shedding light on the financial links between industry and medical practitioners. Coverage is predominantly negative, highlighting problems and concerns with the newly-launched Federal program.

US News & World Report (10/1, Leonard, 661K) reports that that much-anticipated launch of a Federal database detailing payments between the pharmaceutical industry and physicians was greeted with concern, noting “yet another rocky web rollout by the federal government’s health care agency Tuesday resulted in incomplete, unclear data.” The identities of 40% of recipients were concealed due to fears of inaccuracies, representing 65% of all transactions. Before the database’s launch, only 26,000 physicians of the 550,000 named logged into a Federal system to review information about themselves. In a statement, Dr. Robert Wah, President of the American Medical Association, wrote that the Centers for Medicare and Medicaid Services “provided a short period of time to review and correct any inaccurate data that was submitted by industry.”

In a similarly negative assessment of the release titled “As Payments Database Debuts, Doctors Urge Caution,” Kaiser Health News (10/1, Luthra, 2K) reports that Dr. Wah and other advocates previously called for CMS to delay the database launch to March 31 of next year. Currently, data are available to researchers using statistical software. CMS plans to launch a consumer-oriented site later this month. The Affordable Care Act called for the creation of the database. (PR)

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