Insomnia in chronic lower back pain: Non-pharmacological physiotherapy interventions

Abstract

Background: Managing chronic lower back pain (CLBP) is a challenging issue for physiotherapists working in musculoskeletal clinics because of its complex bio-psychosocial nature. Sleep disturbance is one of the common complaints in CLBP patients. Aims: To bring an awareness and understanding of: the prevalence of sleep disturbance in CLBP; the effects of anxiety and stress on sleep; the effects of poor sleep on pain; and non-pharmacological management of insomnia Methods: A relevant literature search was conducted using the terms ‘back pain and sleep disturbance’, ‘back pain and insomnia’, ‘insomnia and stress, anxiety’, ‘sleep and inflammation’ and ‘non-pharmacological treatment of insomnia’. Relevant articles were analysed to understand the prevalence, effects of insomnia on CLBP and the non-pharmacological treatments of insomnia. Results: There is evidence for sleep disturbance in CLBP patients. Pain, anxiety, depression and stress are associated not only with CLBP but also with insomnia. Non-pharmacological treatments like sleep hygiene, cognitive behavioural therapy (CBT), exercise and stimulus control are effective in improving sleep quality. Conclusion: Understanding the nature and extent of sleep disturbance in CLBP and the non-pharmacological treatments of insomnia should be an integral part of CLBP management, factors which are often neglected and poorly understood by physiotherapists.