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Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects

PainSci » bibliography » Gerhart et al 2017
Tags: etiology, back pain, chronic pain, sleep, pro, pain problems, spine

Three articles on PainSci cite Gerhart 2017: 1. The Complete Guide to Low Back Pain2. 6 Main Causes of Morning Back Pain3. Insomnia Until it Hurts

PainSci commentary on Gerhart 2017: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This experiment was all about the chicken/egg question of pain and insomnia in 105 chronic low back pain patients, who bravely filled out five questionnaires per day for two weeks, tracking and rating many aspects of their pain and sleep quality. The main goal was to study “lagged temporal associations”: what happens after what? Are bad sleeps followed by bad days with back pain? Are rough days with back pain followed by lousy sleeps?

Yes and no to those two questions.

Poorer sleep was strongly linked to everything being worse — which is about as surprising as a dog barking at a squirrel. It’s the timing of that relationship that this study zoomed in on, and not only did a bad night clearly herald trouble across the board the next day — more pain, more disability, more doom and gloom (“catastrophizing”) — but “especially during the early part of the day.”

The relationship did not flow the other way. That is, bad nights were likely to be followed by bad days… but bad days were not followed by bad nights.

Gerhart et al shines a nice bright light on a simple old question. The answer isn’t much of a shock to anyone who struggles with both back pain and insomnia, but it’s important and surprisingly rare to confirm this stuff with a good study.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Poor sleep quality among people with chronic low back pain appears to be related to worse pain, affect, poor physical function, and pain catastrophizing. The causal direction between poor sleep and pain remains an open question, however, as does whether sleep quality exerts effects on low back pain differently across the course of the day.

PURPOSE: This daily diary study examined lagged temporal associations between prior night sleep quality and subsequent day pain, affect, physical function and pain catastrophizing, the reverse lagged temporal associations between prior day pain-related factors and subsequent night sleep quality, and whether the time of day during which an assessment was made moderated these temporal associations.

METHODS: Chronic low back pain patients (n = 105) completed structured electronic diary assessments five times per day for 14 days. Items included patient ratings of their pain, affect, physical function, and pain catastrophizing.

RESULTS: Collapsed across all observations, poorer sleep quality was significantly related to higher pain ratings, higher negative affect, lower positive affect, poorer physical function, and higher pain catastrophizing. Lagged analyses averaged across the day revealed that poorer prior night sleep quality significantly predicted greater next day patient ratings of pain, and poorer physical function and higher pain catastrophizing. Prior poorer night sleep quality significantly predicted greater reports of pain, and poorer physical function, and higher pain catastrophizing, especially during the early part of the day. Sleep quality × time of day interactions showed that poor sleepers reported high pain, and negative mood and low function uniformly across the day, whereas good sleepers reported relatively good mornings, but showed pain, affect and function levels comparable to poor sleepers by the end of the day. Analyses of the reverse causal pathway were mostly nonsignificant.

CONCLUSIONS: Sleep quality appears related not only to pain intensity but also to a wide range of patient mood and function factors. A good night’s sleep also appears to offer only temporary respite, suggesting that comprehensive interventions for chronic low back pain not only should include attention to sleep problems but also focus on problems with pain appraisals and coping.

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