Abstract
Insomnia is a major problem in the chronic spinal pain (CSP) population and has a negative impact on health and well-being. While insomnia is commonly reported, underlying mechanisms explaining the relation between sleep and pain are still not fully understood. Additionally, no reviews regarding the prevention of insomnia and/or associated factors in people with CSP are currently available. To gain a better understanding of the occurrence of insomnia and associated factors in this population, we conducted a systematic review of the literature exploring associates for insomnia in people with CSP in PubMed, Web of Science and Embase. Three independent reviewers extracted the data and performed the quality assessment. A meta-analysis was conducted for every potential associate presented in at least two studies. A total of 13 studies were found eligible, which together identified 25 different potential associates of insomnia in 24,817 people with CSP. Twelve studies had a cross-sectional design. Moderate-quality evidence showed a significantly higher rate for insomnia when one of the following factors was present: high pain intensity, anxiety and depression. Low-quality evidence showed increased odds for insomnia when one of the following factors was present: female sex, performing no professional activities and physical/musculoskeletal comorbidities. Higher healthcare use was also significantly related to the presence of insomnia. One study showed a strong association between high levels of pain catastrophizing and insomnia in people with chronic neck pain. Last, reduced odds for insomnia were found in physically active people with chronic low back pain compared to inactive people with chronic low back pain. This review provides an overview of the available literature regarding potential associates of insomnia in people with CSP. Several significant associates of insomnia were identified. These findings can be helpful to gain a better understanding of the characteristics and potential origin of insomnia in people witch CSP, to identify people with CSP who are (less) likely to have insomnia and to determine directions of future research in this area.
Highlights
Chronic spinal pain (CSP) is a highly prevalent and debilitating condition associated with poor quality of life and high socioeconomic impact [1,2,3,4,5]
Studies were eligible when meeting the following criteria: (1) including adults (>18 years) suffering from non-specific CSP for at least 3 months, (2) reporting insomnia-related outcomes [19,20], such as variables described in terms of sleep disturbances, sleep difficulties, sleep problems, restless sleep, disturbed sleep and sleep continuity;,(3) presenting data to identify associated factors
The meta-analysis revealed that people with CSP with high pain intensity levels (VAS/NRS ≥ 7) are more likely to have insomnia compared to those with lower pain intensity levels (ORp 2.86, 95% confidence interval (CI) = (1.83–4.48), p < 0.001, moderate-quality evidence) (Figure 2G)
Summary
Chronic spinal pain (CSP) is a highly prevalent and debilitating condition associated with poor quality of life and high socioeconomic impact [1,2,3,4,5]. CSP can coexist with many comorbidities (like other chronic diseases), which generally leads to larger negative effects on physical and mental functioning, a reduced treatment response, higher levels of disability and higher costs compared to CSP alone [6,7,8]. Insomnia negatively impacts mood, physical symptoms, pain sensitivity, fatigue and health-related quality of life [13,14]. Considering all of the above, co-occurring CSP and insomnia present a serious public health challenge which is currently rarely addressed in treatment [11]
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