Quality of sleep in patients with chronic low back pain: a case-control study

Abstract

Animal experiments and studies in humans clearly show that the relation between pain (acute and chronic) and sleep quality is two-way: sleep disorders can increase pain, which in turn may cause sleep disorders. Sleep disorders and chronic low back pain are frequent health problems and it is unsurprising that the two can co-exist. This study was conducted to evaluate if sleep disorders and chronic pain associated are more frequently than one would expect. The objective of the study was to compare sleep quality in a population of patients with chronic low back pain and a control population. Sleep quality was assessed in 101 patients with chronic low back pain (CLBP) and in 97 sex- and age-matched healthy control subjects using the Pittsburgh Sleep Quality Index [PSQI; score from 0 (no disorder) to 21]. The French version of the Dallas Pain Questionnaire (DPQ) was used to assess the impact of low back pain on patients' quality of life. This impact was taken as nil in the healthy controls. The patients with CLBP and the controls were comparable in age, sex, and height, but mean bodyweight was higher in the CLBP group (70.3 +/- 14.5 vs. 61.8 +/- 11.4 kg; P < 0.05). The patients with CLBP were also more frequently on sick leave than the controls (32.3%; n = 31 vs. 0.0% n = 0; P < 0.001). Coffee, tea, and cola intakes were comparable in the two groups. Patients with CLBP had statistically higher scores in all items of the PSQI than the healthy controls. The mean PSQI was 4.7 +/- 3.2 for the healthy controls and 10.9 +/- 7.9 for the patients with CLBP (P < 0.0001). Sleep disorders were greater when the impact of CLBP on daily life (the four aspects of the DPQ) was greater [P < 0.0001]). The sleep of the patients with CLBP was significantly altered compared with that of the healthy controls, in proportion to the impact of low back pain on daily life. Our findings do not indicate whether sleep disorders are a cause or a consequence of CLBP.

Erratum to: Prevalence of sleep disturbance in patients with low back pain

“…Using the sleep item from the Roland and Morris Disability Questionnaire ''I sleep less well because of my back'', we found that 58.9% (95% CI 56.4-60.7%) of the participants reported that their back pain disturbed their sleep. This is slightly higher than the prevalence rates reported in previous studies conducted in smaller more homogeneous samples where the rates ranged from 50 to 55% [7,11,20,21]. Given the effects of poor sleep, for example increased fatigue, daytime sleepiness and low mood [12], the presence of disturbed sleep is likely to lead to poor outcomes and to complicate the management of LBP.…”

“…Previous studies on low back pain and sleep disturbance were conducted on patients with persistent pain [7,19,20,22]. Our study is the first to consider sleep disturbance in patients with acute LBP.…”

“…LBP which lasts for more than 3 months [6]. There are several important consequences of LBP including work loss [7], disability and depression [8]. Considerable attention has been applied to understanding and managing these problems [9], often with limited success.…”

“…Other research suggests that improved sleep quality might reduce pain and daytime symptoms of patients with arthritis [16]. It is currently unclear how common sleep disturbance is for patients who are seeking care for their LBP, as estimates have been based on either highly selected groups of patients, such as the elderly or those attending specialist pain clinics [17][18][19], or small samples of chronic LBP patients [7,20,21]. These studies are likely to provide prevalence estimates that may not generalise to more heterogeneous samples of patients who are seeking care for their LBP.…”

Teaching Chronic Pain in the Family Medicine Residency

“…2 Chronic pain is associated with multiple negative effects, including mood disorders, 3 sleep impairment, 4 and decreased quality of life. 5 Despite the significance of chronic pain, patients report that their pain is undertreated, and many patients change physicians due to lack of satisfaction with their level of pain control.…”