Persistent and Developing Sleep Problems: A Prospective Cohort Study on the Relationship to Poor Outcome in Patients Attending a Pain Clinic with Chronic Low Back Pain

Abstract

Sleep problems are common in people with low back pain (LBP), however the mechanisms on how sleep influences pain are complex. To date there is a lack of prospective research on the timings and the development of sleep problems in those who have LBP, such information would be useful to identify individuals at risk of poor outcome. Aims are to investigate the predictive role of sleep problems on self-report recovery and pain intensity using logistic regression reporting Odds Ratios (OR). An observational cohort of 761 chronic LBP patients recruited from a pain management clinic participated, and completed data at baseline, and at 6 month follow-up (n = 682). Results show an increased odds of reported non-recovery (OR 1.52) and pain intensity (OR 2.69) for those who report sleep problems at baseline. Further analysis on the experience of sleep problems through time show that those with developing sleep problems (i.e. no sleep problems at baseline but reported sleep problems at follow-up) were at increased odds of reporting non-recovery (OR 2.17) and pain intensity (OR 2.95), as was those who reported sleep problems at both baseline and follow-up, for recovery (OR 2.88), and pain intensity (OR 3.45). Those with resolving sleep problems (i.e. sleep problems present at baseline but not at follow-up) were at a decreased odds of non-recovery (OR 0.50) and pain intensity (0.49). Presenting, persistent, and developing sleep problems have a significant impact on recovery for those with LBP, clinicians may wish to consider treatment options that can address sleep problems.

Influence of sleep problems and co-occurring musculoskeletal pain on long-term prognosis of chronic low back pain: the HUNT Study

“…Few studies have investigated the influence of sleep problems on the prognosis of chronic LBP. A recent study of patients with LBP showed that co-existing sleep problems lowered the probability of recovering from LBP at 6 months follow-up 7. Furthermore, an observational study of persons with occasional LBP showed that sleep problems increased the risk of developing troublesome LBP at 4 years follow-up 10.…”

“…Sleep problems are common among people with chronic LBP 2–4. It has been shown that insomnia symptoms increase the risk of chronic LBP5 and that poor sleep is associated with subsequent pain intensity6 and persistence of pain7 in people with LBP. Furthermore, experimental studies have revealed a possible pathway between poor sleep and pain by showing that sleep deprivation leads to elevated levels of pro-inflammatory cytokines8 and alterations in central pain processing 9.…”

The Effect of the Treatment at a Pain Clinic on the Patients’ Assessment of Their Pain Intensity and the Incidence of Mental Disorders in the form of Anxiety, Depression, and Aggression

“…Thus, both the treatment of pain intensity given at the pain clinic and the associated emotional disturbances in the form of anxiety and aggression proved to have been effective. Pain is closely linked to the occurrence of emotional disturbances, which is confirmed by the studies of Pakpou et al (2018), Sagheer et al (2013), and Ahmed et al (2013) [24,25,26]. The study of Merrick et al (2012), who did a year-long observation of two rehabilitation management strategies of chronic pain in patients treated at the rehabilitation clinic of the University Hospital of Umeå, Sweden, shows that the patients enrolled in the multimodal rehabilitation program reported a lack of pain symptoms in a statistically significant number of cases (59% vs. 46%).…”

Effects of spinal manipulation and pain education on pain in patients with chronic low back pain: a protocol of randomized sham-controlled trial

“…Other factors such as kinesiophobia, pain catastrophizing, inappropriate beliefs about pain, sleep problems, and depression may also contribute to the central sensitization and pain chronification. 13 , 14 …”