The Association between Sleep and Chronic Spinal Pain: A Systematic Review from the Last Decade

Looveren, Eveline Van; Bilterys, Thomas; Munneke, Wouter; Cagnie, Barbara; Ickmans, Kelly; Maîresse, Olivier; Malfliet, Anneleen; Baets, Liesbet De; Nijs, Jo; Goubert, Dorien; Danneels, Lieven; Moens, Maarten; Meeus, Mira

doi:10.3390/jcm10173836

Cited by 33 publications

(35 citation statements)

References 70 publications

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“…Similarly, evidence on the effect of pain duration on pain intensity is contradictory. The data from Nicassio et al [ 14 ], Luyster et al [ 13 ] and Van Looveren et al [ 6 ] showed no effect, while O’Brien et al [ 12 ] described that duration of pain predicts a more significant pain in CLBP individuals. The difference between our results and those of Sezgin et al [ 10 ] and O’Brien et al [ 12 ] regarding the effect of pain duration on SQ and pain could be down to the heterogeneity of diagnoses and pain durations of the individuals included in our study (35.96% acute vs. 64.04% chronic).…”

Section: Discussionmentioning

confidence: 99%

“…In line with Treede et al [ 26 ], the variable Pain included the following factors: pain intensity (static, at movement and average of the last 7 days), interference of pain in daily activities and distress relative to pain. A model was analyzed in which the SQ variable predicts the pain variable based on the current evidence describing that SQ predicts pain more strongly than pain predicts SQ [ 4 , 5 , 6 ]. Additionally, the variables sex and duration of pain were included in the model to control SQ and pain.…”

Section: Methodsmentioning

confidence: 99%

“…Although some studies have described the relationship between SQ and pain as bidirectional [ 3 ], recent evidence indicates that SQ predicts pain more strongly than pain predicts SQ [ 4 , 5 , 6 ]. Poor SQ can alter key processes in pain perception.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Sleep Quality on Pain in Chilean Individuals with Musculoskeletal Disorders

Bascour‐Sandoval

Belmar-Arriagada

Albayay

et al. 2021

IJERPH

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Poor sleep quality (SQ) negatively affects pain associated with musculoskeletal disorders (MSD). As the level of economic development of a country determines its sanitary conditions, these can influence the sleep–pain relationship; therefore, it is relevant to generate evidence in the population with MSD in developing countries. This cross-sectional study sought to determine the effect of poor SQ on pain in Chilean individuals with MSD, controlling for sex and duration of pain (in months). Method: A total of 228 individuals were included. SQ was measured with the Pittsburg Sleep Quality Index (PSQI), pain (intensity, interference and distress relative to pain) was measured with visual analog scales. Structural equation modeling (SEM) was performed to analyze the effect of SQ on pain. Results: A high frequency of poor SQ was present in the studied group, and was more prevalent in women. The SEM model evidenced that poor SQ predicts greater pain. Sex influences sleep quality and pain, but not pain duration. Conclusions: These findings indicate that poor SQ predicts higher pain in MSD and that women exhibit worse SQ and more significant pain than men. Our findings support that SQ should be considered in the comprehensive approach to pain in individuals with MSD.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Effect of Sleep Quality on Pain in Chilean Individuals with Musculoskeletal Disorders

Bascour‐Sandoval

Belmar-Arriagada

Albayay

et al. 2021

IJERPH

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“…Some inevitable limitations should also be mentioned. Firstly, our study cannot evaluate the influence of within-population structures resulting from the between-sex difference in the prevalence of insomnia ( Aili et al, 2015 ; Van Looveren et al, 2021 ). Secondly, MR does not inherently completely expel unknown pleiotropy that affected our results.…”

Section: Discussionmentioning

confidence: 99%

“…Although many observational studies have revealed a bidirectional relationship between sleep disturbances and LBP, the causal association are unclear due to the confounders ( Kelly et al, 2011 ; Goforth et al, 2014 ; Uhlig et al, 2018 ; Ho et al, 2019 ; Bilterys et al, 2021 ; Oliveira et al, 2022 ). A recent review focused on the association between sleep and spinal pain (including LBP) showed weak to moderate evidence of causality ( Van Looveren et al, 2021 ). Thus, further research with more advanced methodology is necessary to establish a cause-and-effect link exists between LBP and sleep disturbances.…”

Section: Introductionmentioning

confidence: 99%

Association of insomnia and daytime sleepiness with low back pain: A bidirectional mendelian randomization analysis

Shu

Ping

et al. 2022

Front. Genet.

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Purpose: Observational research has indicated the presence of a causal relationship between sleep disturbances and low back pain (LBP). However, the link may have been biased by confounding factors. The purpose of this study was to examine the potential causal association of insomnia and daytime sleepiness with LBP by using mendelian randomization (MR).Methods: Genome-wide association study (GWAS) summary statistics of insomnia were obtained from a large-scale GWAS meta-analysis (n = 1,331,010; individuals from UK Biobank and 23andMe) or UK Biobank alone (n = 453,379). The summary statistics of daytime sleepiness were from UK Biobank (n = 452,071) and LBP were provided by the FinnGen Release 6 (210,645 individuals with 16,356 LBP cases and 194,289 controls) or UK Biobank (5,423 cases versus 355,771 controls). Linkage disequilibrium score (LDSC) regression and bidirectional MR analysis was employed to estimate genetic correlation and causal relationship. In the MR analysis, the inverse variance weighted method (IVW) was utilized as the main analysis procedure, while MR-Egger, Weighted median and Robust adjusted profile score (RAPS) were utilized for supplementary analyses.Results: LDSC analysis showed that LBP were significantly genetically correlated with insomnia (rg = 0.57, p = 2.26e-25) and daytime sleepiness (rg = 0.18, p = 0.001). The MR analysis revealed that genetically predicted insomnia was significantly associated with an increased risk of LBP (OR = 1.250, 95% CI: 1.186–1.318; p = 1.69e-16). However, the reverse causality was not confirmed. No evidence was identified supporting causality of daytime sleepiness and LBP.Conclusion: This study demonstrates a putative causal link of insomnia on LBP and a null causal effect of LBP on insomnia. Furthermore, a causal link between daytime sleepiness and LBP were not reported. This finding may stimulate new strategies for patient management in clinical practice, benefiting public health.

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Cognitive Behavioral Therapy for Insomnia in Pain Management for Nonspecific Chronic Spinal Pain

Malfliet,

De Baets,

Bilterys

et al. 2024

JAMA Netw Open

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ImportanceInsomnia is highly prevalent in patients with nonspecific chronic spinal pain (nCSP). Given the close interaction between insomnia and pain, targeting sleep problems during therapy could improve treatment outcomes.ObjectiveTo evaluate the effectiveness of cognitive behavioral therapy for insomnia (CBTi) integrated in best-evidence pain management (BEPM) vs BEPM only in patients with nCSP and insomnia.Design, Setting, and ParticipantsA multicenter randomized clinical trial with 1-year follow-up was conducted between April 10, 2018, and April 30, 2022. Data and statistical analysis were performed between May 1, 2022, and April 24, 2023. Patients with nCSP and insomnia were evaluated using self-report and at-home polysomnography, to exclude underlying sleep pathologic factors. Participants were treated at the University Hospital Brussels or University Hospital Ghent, Belgium. Intention-to-treat analysis was performed.InterventionsParticipants were randomized to either CBTi-BEPM or BEPM only. Both groups received 18 treatment sessions over 14 weeks. The CBTi-BEPM treatment included 6 CBTi sessions and 12 BEPM sessions. The BEPM treatment included pain neuroscience education (3 sessions) and exercise therapy (9 sessions in the CBTi-BEPM group, 15 sessions in the BEPM-only group).Main Outcomes and MeasuresThe primary outcome was change in mean pain intensity (assessed with Brief Pain Inventory [BPI]) at 12 months after the intervention. Exploratory secondary outcomes included several pain- and sleep-related outcomes. Blinded outcome assessment took place at baseline, posttreatment, and at 3-, 6-, and 12-month follow-up.ResultsA total of 123 patients (mean [SD] age, 40.2 [11.18] years; 84 women [68.3%]) were included in the trial. In 99 participants (80.5%) with 12-month BPI data, the mean pain intensity at 12 months decreased by 1.976 points (reduction of 40%) in the CBTi-BEPM group and 1.006 points (reduction of 24%) points in the BEPM-only group. At 12 months, there was no significant difference in pain intensity change between groups (mean group difference, 0.970 points; 95% CI, −0.051 to 1.992; Cohen d, 2.665). Treatment with CBTi-BEPM resulted in a response for BPI average pain with a number needed to treat (NNT) of 4 observed during 12 months. On a preliminary basis, CBTi-BEPM was, consistently over time and analyses, more effective than BEPM only for improving insomnia severity (Cohen d, 4.319-8.961; NNT for response ranging from 2 to 4, and NNT for remission ranging from 5 to 12), sleep quality (Cohen d, 3.654-6.066), beliefs about sleep (Cohen d, 5.324-6.657), depressive symptoms (Cohen d, 2.935-3.361), and physical fatigue (Cohen d, 2.818-3.770). No serious adverse effects were reported.Conclusions and RelevanceIn this randomized clinical trial, adding CBTi to BEPM did not further improve pain intensity reduction for patients with nCSP and comorbid insomnia more than BEPM alone. Yet, as CBTi-BEPM led to significant and clinically important changes in insomnia severity and sleep quality, CBTi integrated in BEPM should be considered in the treatment of patients with nCSP and comorbid insomnia. Further research can investigate the patient characteristics that moderate the response to CBTi-BEPM in terms of pain-related outcomes, as understanding of these moderators may be of utmost clinical importance.Trial RegistrationClinical Trials.gov Identifier: NCT03482856

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The Association between Sleep and Chronic Spinal Pain: A Systematic Review from the Last Decade

Cited by 33 publications

References 70 publications

The Effect of Sleep Quality on Pain in Chilean Individuals with Musculoskeletal Disorders

The Effect of Sleep Quality on Pain in Chilean Individuals with Musculoskeletal Disorders

Association of insomnia and daytime sleepiness with low back pain: A bidirectional mendelian randomization analysis

Cognitive Behavioral Therapy for Insomnia in Pain Management for Nonspecific Chronic Spinal Pain

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