Sleep Disturbance Predicts Less Improvement in Pain Outcomes: Secondary Analysis of the SPACE Randomized Clinical Trial

Abstract

Objective Sleep disturbance may limit improvement in pain outcomes if not directly addressed in treatment. Moreover, sleep problems may be exacerbated by opioid therapy. This study examined the effects of baseline sleep disturbance on improvement in pain outcomes using data from the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial, a pragmatic 12-month randomized trial of opioid vs nonopioid medication therapy. Design Participants with chronic back pain or hip or knee osteoarthritis pain were randomized to either opioid therapy (N = 120) or nonopioid medication therapy (N = 120). Methods We used mixed models for repeated measures to 1) test whether baseline sleep disturbance scores modified the effect of opioid vs nonopioid treatment on pain outcomes and 2) test baseline sleep disturbance scores as a predictor of less improvement in pain outcomes across both treatment groups. Results The tests for interaction of sleep disturbance by treatment group were not significant. Higher sleep disturbance scores at baseline predicted less improvement in Brief Pain Inventory (BPI) interference (β = 0.058, P = 0.0002) and BPI severity (β = 0.026, P = 0.0164). Conclusions Baseline sleep disturbance adversely affects pain response to treatment regardless of analgesic regimen. Recognition and treatment of sleep impairments that frequently co-occur with pain may optimize outcomes.

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

“…Several prospective studies also found that the presence of baseline selfreported sleep disturbances would predict the future onset of CLBP 98,99 or chronic pain 100 in healthy individuals. Similarly, some studies have demonstrated that poorer self-reported sleep quality/quantity at baseline predicts suboptimal pain-related outcomes (eg, future sickness absence, 101 less improvement in pain interference and severity, 38 lower probability of recovery from CLBP, 39 and the onset of new pain or radiating pain 16 ) in patients with CLBP. However, these studies were not included in the current review because they recruited a mixed sample of people with CLBP and other chronic pain, or people with specific CLBP.…”

“…Recently, some prospective studies found that the presence of sleep disturbance at baseline might predict suboptimal improvement in pain severity, a heightened risk of persistent LBP, or a lower likelihood of recovery in patients with CLBP over 12-week to 13-year periods. 16,38,39 However, opposite findings have also been reported. 22 These conflicting results underscore the necessity of conducting a systematic review to summarize the evidence regarding the role of baseline sleep quality/quantity in predicting the prognosis of CLBP, which can inform clinicians regarding the management of patients with concomitant CLBP and sleep problems.…”

“…If improved sleep quality/quantity are related to the improvements of pain intensity, self-perceived recovery and LBP-related disability in patients with CLBP,17,32,36,37 a logical follow-up question is whether baseline sleep quality/quantity of these patients can predict their trajectory of LBP. Recently, some prospective studies found that the presence of sleep disturbance at baseline might predict suboptimal improvement in pain severity, a heightened risk of persistent LBP, or a lower likelihood of recovery in patients with CLBP over 12-week to 13-year periods 16,38,39. However, opposite findings have also been reported 22.…”

Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers

“…Such was reflected in our participants’ considerations for improvements and ideal treatment scenarios. Since research has demonstrated the existence of a complex, bi-directional relationship which informs pain-related insomnia [ 17 , 18 , 20 , 21 , 25 , 66 , 82 – 84 ] further education and information exposure should focus on its clinical application and treatment in line with recommendations of integrated, multidisciplinary service provisions [ 85 ].…”

“…Insomnia alone is a risk factor in the development of many adverse health outcomes, including hypertension, cardiovascular disease, diabetes, respiratory diseases, and increased mortality [ 14 – 16 ]. Poor sleep can be a driver of persistent pain alongside associated distress and disability [ 17 – 25 ].…”