Are Changes in Sleep Quality/Quantity or Baseline Sleep Parameters Related to Changes in Clinical Outcomes in Patients With Nonspecific Chronic Low Back Pain?

Abstract

Objectives: Sleep disturbance is prevalent among patients with chronic low back pain (CLBP). This systematic review aimed to summarize the evidence regarding the: (1) temporal relations between changes in sleep quality/quantity and the corresponding changes in pain and/or disability; and (2) role of baseline sleep quality/quantity in predicting future pain and/or disability in patients with CLBP.Methods: Four databases were searched from their inception to February 2021. Two reviewers independently screened the abstract and full text, extracted data, assessed the methodological quality of the included studies, and evaluated the quality of evidence of the findings using the Grading of Recommendations Assessment Development and Evaluation (GRADE).Results: Of 1995 identified references, 6 articles involving 1641 participants with CLBP were included. Moderate-quality evidence substantiated that improvements in self-reported sleep quality and total sleep time were significantly correlated with the corresponding LBP reduction. Low-quality evidence showed that self-reported improvements in sleep quality were related to the corresponding improvements in CLBP-related disability. There was conflicting evidence regarding the relation between baseline sleep quality/ quantity and future pain/disability in patients with CLBP.Discussion: This is the first systematic review to accentuate that improved self-reported sleep quality/quantity may be associated with improved pain/disability, although it remains unclear whether baseline sleep quality/quantity is a prognostic factor for CLBP. These findings highlight the importance of understanding the mechanisms underlying the relation between sleep and CLBP, which may inform the necessity of assessing or treating sleep disturbance in people with CLBP.

Are Morphometric and Biomechanical Characteristics of Lumbar Multifidus Related to Pain Intensity or Disability in People With Chronic Low Back Pain After Considering Psychological Factors or Insomnia?

“…Our findings also suggest that insomnia is one of the significant predictors of pain intensity in people with CLBP, which concurs with previous research that higher ISI scores were associated with higher pain intensity in people with CLBP (88). Similarly, a recent systematic review revealed low-to moderate-quality evidence that improved sleep quantity/quality is significantly related to improved LBP-related disability or reduced LBP in patients with CLBP (89). However, sleep disturbances and pain may affect each other reciprocally to form a vicious cycle because some brain regions (e.g., mesencephalic periaqueductal gray, thalamus, and raphe magnus) responsible for the initiation and maintenance of sleep are also involved in pain modulation (90).…”

Challenges, Concerns, and Experiences of Community-Dwelling Older Women with Chronic Low Back Pain—A Qualitative Study in Hong Kong, China

“…Most of our participants reported sleep disturbance, which interfered with their daily routine and emotions. Research has suggested that poor sleep aggravated pain by sensitizing pain perception, [ 32 ] while pain can also interfere with one’s sleep quality [ 33 ], resulting in a vicious circle [ 34 ]. Additionally, sleep disturbance can be a major source of psychological distress in people with chronic pain [ 35 ].…”

Sleep Quality in Spine Surgery

“…In a systematic review focusing on sleep disruption and chronic low back pain, it was observed that improvements in self-reported sleep duration and quality were significantly associated with improvements in lower back pain 13. In elderly patients undergoing lumbar spinal surgery, postoperative improvement in sleep quality has been demonstrated to correlate with improvements in disability 14.…”