Associates of Insomnia in People with Chronic Spinal Pain: A Systematic Review and Meta-Analysis

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.

Comparing Types of Yoga for Chronic Low Back and Neck Pain in Military Personnel: A Feasibility Randomized Controlled Trial

“…Low back pain and neck pain are highly prevalent conditions that become chronic in 20–30% of those afflicted. 1 Many people with chronic pain also experience decreased functional ability, 2 lower productivity in work settings, 3 , 4 increased psychological symptoms, (depression, 5 , 6 anxiety 7 , 8 ), lower sleep quality, 9 , 10 and higher health care costs. 11 Recommended treatment for chronic low back pain (cLBP) and chronic neck pain (cNP) typically begins with medication management and self-care information, 12 but the limited effectiveness of these approaches and risks associated with pain medication magnifies the need for additional non-pharmacologic treatment options.…”

The impact of comorbid spinal pain in depression on work participation and clinical remission following brief or short psychotherapy. Secondary analysis of a randomized controlled trial with two-year follow-up

“…Likewise, it is unsure whether improvements in pain and anxiety helps the patients’ depressive symptoms or vice versa, or whether a common other factor is related to the severity and response of both depression, anxiety and pain [ 15 ]. Insomnia or fear-avoidance beliefs might be such a factor; related to both reduced mental health and chronic pain and reduced treatment effectiveness [ 95 ]. However, both factors were reported equally high in both subgroups and therefore not included as potential covariates.…”

The Key Role of Lifestyle Factors in Perpetuating Chronic Pain: Towards Precision Pain Medicine

“…First, a state-of-the-art review provided recommendations for best practices in the clinical assessment and treatment approaches to promote sleep health in children and adolescents with chronic pain [ 12 ]. Second, a systematic literature review with meta-analyses provides an overview of the associates of insomnia in people with chronic spinal pain, highlighting several significant associates of insomnia in this population [ 13 ]. This review is helpful in gaining a better understanding of the characteristics and potential origin of insomnia in patients with chronic spinal pain, including identifying patients with chronic spinal pain who are likely to have insomnia [ 13 ].…”

“…Second, a systematic literature review with meta-analyses provides an overview of the associates of insomnia in people with chronic spinal pain, highlighting several significant associates of insomnia in this population [ 13 ]. This review is helpful in gaining a better understanding of the characteristics and potential origin of insomnia in patients with chronic spinal pain, including identifying patients with chronic spinal pain who are likely to have insomnia [ 13 ]. Finally, an original research report presents the cross-cultural translation and validation of the Pain and Sleep Questionnaire three-item index (PSQ-3) [ 14 ], allowing implementation of the PSQ-3 in Finland, potential leading to better understanding of the direct effects of pain on sleep in Finish patients with chronic pain [ 14 ].…”