Persistent and Developing Sleep Problems: A Prospective Cohort Study on the Relationship to Poor Outcome in Patients Attending a Pain Clinic with Chronic Low Back Pain.

Abstract

Sleep problems are common in people with low back pain (LBP); however, the mechanisms of how sleep influences pain are complex. To date there is a lack of prospective research on the timing and development of sleep problems in those who have LBP; such information would be useful to identify individuals at risk for poor outcomes. Our aims are to investigate the predictive role of sleep problems on self-report recovery and pain intensity using logistic regression reporting odds ratios (ORs). An observational cohort of 761 chronic LBP patients recruited from a pain management clinic participated, and they completed data at baseline and at 6-month follow-up (n=682). Results show increased odds for reported nonrecovery (OR 1.52) and pain intensity (OR 2.69) among those who reported sleep problems at baseline. Further analysis on the experience of sleep problems through time showed that those with developing sleep problems (ie, no sleep problems at baseline but reported sleep problems at follow-up) were at increased odds for reporting nonrecovery (OR 2.17) and pain intensity (OR 2.95), as were those who reported sleep problems at both baseline and follow-up, for recovery (OR 2.88) and pain intensity (OR 3.45). Those with resolving sleep problems (ie, sleep problems present at baseline but not at follow-up) were at decreased odds for nonrecovery (OR 0.50) and pain intensity (0.49). Presenting, persistent, and developing sleep problems have a significant impact on recovery for those with LBP. Clinicians may wish to consider treatment options that can address sleep problems.