Insomnia in chronic non-specific low back pain

Patients with chronic non-specific low back pain (CNSLBP) often have sleep disturbances (insomnia), which negatively affects pain severity, mental state, activities of everyday living, and the overall quality of life. The prevalence of insomnia in patients with CNSLBP and the effectiveness of its therapy require further investigation.

Objective: to identify the prevalence of insomnia and the effectiveness of its treatment in CNSLBP.

Patients and methods. The study included 71 patients aged 18–75 years (mean age 55.09±13.0 years) with CNSLBP. A single sleep hygiene educational session was run in the standard treatment group (n=34; mean age – 51±14 years). Intervention in the extended therapy group (n=37; mean age – 59±12 years) included an educational program dedicated to sleep, which was an individual face-to-face course of 4–5 sessions over two weeks and a telephone survey after three months. We used the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) to assess sleep disturbances, a numerical rating scale (NRS) to assess pain, the International Physical Activity Questionnaire (IPAQ-SF), and the 12-item short form health survey (SF-12) to assess physical activity and quality of life. The survey was carried out three times (at the admission, after 7–10 and 80–90 days).

Results and discussion. In both groups of patients with CNSLBP, PSQI scores improved in a week and after 3 months compared with baseline (p<0.05). Sleep quality between 7^th and 90^th days significantly improved only in the extended therapy group (p=0.025). ISI scores significantly improved during inpatient treatment in both groups (p<0.05), but between 7^th and 90^th days significantly improved only in the extended therapy group (р=0.048). Back pain intensity according to NRS significantly decreased in a week and after 3 months, compared to baseline (р<0.0001). Significant increase in physical activity (p≤0.001), physical and mental components of quality of life (p<0.05) were found only in the extended therapy group.

Conclusion. Most patients with CNSLBP have insomnia, the treatment of which can improve sleep and help reduce pain.

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