Influence of the COVID-19 pandemic on sleep quality, psychosocial aspects, and physical activity levels in patients with chronic pain in Brazil: COVIDor cross-sectional study

Pereira, Thaís Alves Barreto; Santos, Annanda Oliveira; Almeida, Akeline Santos de; Dantas, Maria Ivone Oliveira; DeSantana, Josimari Melo

doi:10.5935/2595-0118.20230095-en

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ORIGINAL ARTICLE • BrJP 7 • 2024 • https://doi.org/10.5935/2595-0118.20230095-en copy

Influence of the COVID-19 pandemic on sleep quality, psychosocial aspects, and physical activity levels in patients with chronic pain in Brazil: COVIDor cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

Social isolation of COVID-19 pandemic maximized painful symptoms in chronic pain.
COVID-19 pandemic exacerbated anxiety and reduced sleep quality in chronic pain.
These factors were associated with the reduction of physical activity levels.

GRAPHICAL ABSTRACT

ABSTRACT

BACKGROUND AND OBJECTIVES:

The social distancing of COVID-19 pandemic exacerbated symptoms of chronic pain patients. Furthermore, it is necessary to consider the sociocultural context of coping with the pandemic in different countries. The objective of this study was to evaluate pain, psychoemotional symptoms, sleep quality, and level of physical activity in chronic pain patients during the COVID-19 pandemic in Brazil.

METHODS:

Individuals with fibromyalgia, migraine and chronic low back pain were included. The survey was performed through a questionnaire elaborated by researchers on the Forms application, from Google Drive, in the period between October 2020 and March 2021, with straight and clear questions about pain, psychoemotional aspects, sleep quality, and level of physical activity. Binary or multinominal logistic regression analysis was performed to identify possible predictors.

RESULTS:

973 people were evaluated, 63.5% had fibromyalgia, and 98.3% were female. Anxiety increased the odds ratio in 395% of chronic pain patients to feel pain (ß: 1.375; OR: 3.956; p=0.001) and a greater intensity of pain increases in 62.3% the chance of these individuals not performing physical activity (ß: -0.474; OR: 0.623; p=0.001). Pain intensity increased the odds ratio of having insomnia by 186.9% (ß: 0.625; OR: 1.869; p=0.001) and the chance of taking sleep drugs by 160.4% (ß: 0.472; OR: 1.604; p=0.001).

CONCLUSION:

The social isolation of COVID-19 pandemic maximized the vicious cycle between painful symptoms, anxiety, and sleep disorders in chronic pain patients in Brazil. The intensification of these factors is associated with the reduction of physical activity levels.

Keywords
Anxiety; Chronic pain; COVID-19; Physical activity; Sedentary behavior; Sleep quality

Variables		n	%
Gender	Female	956	98.3
	Male	17	1.7%
Age (years)	12 - 20	16	1.6%
	21 - 30	148	15.1%
	31 - 59	783	80.1%
	≥ 60	30	3.1%
Schooling	Primary	24	2.5%
	Incomplete high school	54	5.6%
	Complete high school	209	21.6%
	Undergraduate	167	17.3%
	Graduate	512	53.0%
Social isolation	No	374	38.6%
	Yes	594	61.4%
Employment before the pandemic	Unemployed	172	17.8%
Employment before the pandemic	Student	57	5.9%
	Temporary employee	44	4.5%
	Permanent employee	410	42.3%
	Self-employed	234	24.1%
	Retired	52	5.4%
Did you keep wor-king?	Yes (essential sector)	188	23.4%
Did you keep wor-king?	Yes (remote work)	247	30.7%
	No (temporarily)	172	21.4%
	No (unemployed)	198	24.6%
If a student, were your classes main-tained by virtual means?	Yes	223	76.9%
	No, suspended classes	49	16.9%
	No, I don’t have equipment or internet access	18	6.2%
Total		973	100%

Variables		n	%
Have you felt pain?	No	9	0.9
	Yes	968	99.1
Did the pain get better or worse?	Better	76	7.8
Did the pain get better or worse?	Worse	732	74.9
	No changes	169	17.3
Pain intensity in the last se-ven days	Mild (0-3)	27	2.8
Pain intensity in the last se-ven days	Moderate (4-7)	279	28.6
	Intense (8-10)	668	68.6
How many days have you been in pain this past week?	Every day	652	66.7
	Almost everyday	213	21.8
	Couple of days	72	7.4
	A few days	35	3.6
	No day	6	0.6
How much pain interfe-red with your activities at home?	Did not interfere	22	2.3
	A little	138	14.2
	Moderately	241	24.7
	A lot	574	58.9
How much pain interfered with your work or study ac-tivities?	Did not interfere	45	4.8
	A little	128	13.6
	Moderately	267	28.3
	A lot	502	53.3
Have you been doing phy-sical activity?	No	644	66.5
Have you been doing phy-sical activity?	Yes	324	33.5
Frequency of physical acti-vities (days)	1 - 2	127	37.0
Frequency of physical acti-vities (days)	3 - 4	132	38.5
	5 - 7	84	24.5
Have you helped with hou-sehold chores?	Everyday	514	52.8
Have you helped with hou-sehold chores?	Almost every day	153	15.7
	Couple of days	136	14.0
	A few days	146	15.0
	No day	25	2.6
Anxiety	No anxiety (0)	15	1.5
	Mild (1-4)	60	6.2
	Moderate (5-7)	255	26.2
	Intense (8-10)	643	66.1
Has anxiety interfered with your activities in the past seven days?	Did not interfere	83	8.5
	A little	178	18.2
	Moderately	241	24.7
	A lot	474	48.6
Sleep quality	Very good	21	2.2
	Good	64	6.6
	Regular	258	26.4
	Bad	302	30.9
	Very bad	331	33.9
Have you had insomnia?	No	214	22.0
	Yes	760	78.0
Did you take sleeping pills before the pandemic?	No	510	52.4
Did you take sleeping pills before the pandemic?	Yes	464	47.6
Are you taking sleeping pills?	No	465	47.7
Are you taking sleeping pills?	Yes	510	52.3
Total		973	100

Classification	β	OR	Lower/upper limit	p-value
Anxiety	1.375	3.956	2.079-7.529	0.000^* * p <0.05.
Constant	0.413	1.511	-	0.642

Classification	β	OR	Lower/upper limit	p-value
Has felt pain	0.261	1.298	0.259-6.498	0.751
Pain intensity	0.625	1.869	1.382-2.528	0.000^* * p <0.05.
Anxiety	0.604	1.829	1.461-2.290	0.000^* * p <0.05.
Physical activity	-0.194	0.824	0.586-1.158	0.265
Sleep drug	0.895	2.448	1.752-3.419	0.000^* * p <0.05.
Constant	-4.640	0.010	-	0.004

Classification	β	OR	Lower/upper limit	p-value
Intensity of pain	0.472	1.604	1.252-2.054	0.000^* * p <0.05.
Anxiety	0.168	1.183	0.972-1.439	0.093
Constant	-2.223	0.108	-	0.000

Classification	β	EP	OR	Lower/ upper limit	p-value
1 - 2 days
Quarantine (No)	-0,277	0.282	0.758	0.436-1.319	0.327
Quarantine (Yes)		1	1	1	1
Sleep drug (No)	0.572	0.254	1.771	1.078-2.912	0.024^* * <0.05.
Sleep drug (Yes)		1	1	1	1
5 - 7 days
Quarantine (No)	-0.465	0.337	0.628	0.324-1.216	0.168
Quarantine (Yes)		1	1	1	1
Sleep drug (No)	0.984	0.292	2.675	1.509-4.740	0.001^* * <0.05.
Sleep drug (Yes)		1	1	1	1

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