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Research Review Corner: Chronic LBP and Sleep


October 27, 2011
By Shawn Thistle

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BACKGROUND INFORMATION
It is well known that low back pain, particularly the chronic variety (CLBP), represents a significant clinical, economic and societal issue. As chiropractors, we normally focus on the mechanical or physical aspects of CLBP, yet this condition can affect many aspects of a patient’s life in addition to physical function, such as work capacity, psychological well-being and sleep. In fact, nearly 50 per cent of CLBP patients report sleep disturbance,1,2 a general term that can encompass poor sleep quality, reduced sleep efficiency (ratio of sleep time to time in bed), reduced sleep duration, delayed sleep onset, fragmentation of sleep architecture, increased activity or movement during sleep, and non-restorative sleep.

Study Title: The Association Between Chronic Low Back Pain and Sleep – A Systematic Review
Authors: Kelly GA et al.
Publication Information: Clinical Journal of Pain, 2011; 27: 169-181. 


BACKGROUND INFORMATION

It is well known that low back pain, particularly the chronic variety (CLBP), represents a significant clinical, economic and societal issue. As chiropractors, we normally focus on the mechanical or physical aspects of CLBP, yet this condition can affect many aspects of a patient’s life in addition to physical function, such as work capacity, psychological well-being and sleep. In fact, nearly 50 per cent of CLBP patients report sleep disturbance,1,2 a general term that can encompass poor sleep quality, reduced sleep efficiency (ratio of sleep time to time in bed), reduced sleep duration, delayed sleep onset, fragmentation of sleep architecture, increased activity or movement during sleep, and non-restorative sleep.

The importance of sleep to human function is obvious – restoration, growth and energy conservation. However, many people experience sleep disorders. From a clinical perspective, there is abundant research showing that pain is increased when sleep is deprived. This can result in a deteriorating cycle (similar to a “pain-spasm” cycle): increased pain leads to diminished sleep, which leads to increased pain, and so on. To compound the problem, pain medications, such as opioids, are known to adversely affect sleep architecture.3

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Therefore, the management of any chronic pain syndrome, including CLBP, should include a strategy to address sleep disturbance. Typically, sleep research has focused on chronic pain populations such as fibromyalgia, irritable bowel syndrome, osteoarthritis, cancer pain, headache/migraine and chronic fatigue syndrome patients. This systematic review aimed to determine the relationship between sleep and CLBP and discussed directions for future research.

PERTINENT RESULTS
Seventeen articles fulfilled the inclusion criteria – 14 quantitative and three qualitative. Of the quantitative studies, three were rated as weak, 10 as moderate and one as strong in quality. All three qualitative studies were rated as “strong” in quality. Review of the results of these studies revealed:

  • CLBP relates to many aspects of sleep, including sleep disturbance and duration (15 studies), sleep affecting daytime function (five studies), sleep quality (four studies), ability to fall asleep (three studies) and activity during sleep (three studies);
  • Consistent evidence demonstrated that CLBP was associated with greater sleep disturbance, reduced sleep duration and quality, increased time to fall asleep, poor daytime function, and greater sleep dissatisfaction and distress;
  • Inconsistent evidence was found for an adverse association between CLBP and sleep efficiency and activity.


CONCLUSIONS AND PRACTICAL APPLICATIONS

An important take-home message from this systematic review is that practitioners dealing with CLBP patients should ask their patients about sleep and attempt to assist those in need with this aspect of their lives. It should be noted that the efficacy of various interventions for managing sleep disturbance requires further study and was not the focus of this review.

From a practical perspective, most of us would agree that patients in any sort of pain heal faster or turn a major corner once their sleep normalizes. This study validates this observation and paves the way for more research in this area to better equip us to manage CLBP in a holistic manner.

To read this review in full, including complete pertinent results section, study strengths and weaknesses and additional references, please visit www.cndoctor.ca.


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