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Insomnia in chronic non-specific low back pain

https://doi.org/10.14412/2074-2711-2021-5-62-67

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Abstract

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 7th and 90th 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 7th and 90th 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.

About the Authors

I. A. Lamkova
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Department of Nervous System Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine

11, Rossolimo St., Build. 1, Moscow 119021



V. A. Parfenov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Vladimir Anatolevich Parfenov

Department of Nervous System Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine

11, Rossolimo St., Build. 1, Moscow 119021



References

1. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3 rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.

2. Mathias JL, Cant ML, Burke ALJ. Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis. Sleep Med. 2018 Dec;52:198-210. doi: 10.1016/j.sleep.2018.05.023. Epub 2018 Jun 11.

3. Andersen ML, Araujo P, Frange C, Tufik S. Sleep Disturbance and Pain: A Tale of Two Common Problems. Chest. 2018 Nov;154(5):1249-59. doi: 10.1016/j.chest.2018.07.019. Epub 2018 Jul 27.

4. Finan PH, Remeniuk B. Is the brain reward system a mechanism of the association of sleep and pain? Pain Manag. 2016;6(1):5-8. doi: 10.2217/pmt.15.48. Epub 2015 Dec 17.

5. Eadie J, van de Water AT, Lonsdale C, et al. Physiotherapy for sleep disturbance in people with chronic low back pain: results of a feasibility randomized controlled trial. Arch Phys Med Rehabil. 2013 Nov;94(11):2083-92. doi: 10.1016/j.apmr.2013.04.017. Epub 2013 May 2.

6. Harvey AG, Belanger L, Talbot L, et al. Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: a randomized controlled trial. J Consult Clin Psychol. 2014 Aug;82(4):670-83. doi: 10.1037/a0036606. Epub 2014 May 26.

7. Lamkova IA, Parfenov VA. Questions of the use of kinesitherapy for chronic nonspecific lumbodynia. Annaly klinicheskoy i eksperimental'noy nevrologii. 2021;15 (in press) (In Russ.).

8. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001 Jul;2(4):297-307. doi: 10.1016/s1389-9457(00)00065-4

9. Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4

10. Craig CL, Marshall AL, Sjöström M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381-95. doi: 10.1249/01.MSS.0000078924.61453.FB

11. IPAQ Core Group. Guidelines for data processing and analysis of IPAQ – short and long forms. 2005; 1-15. Available from: http://www.ipaq.ki.se/scoring.pdf

12. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996 Mar;34(3):220-33. doi: 10.1097/00005650-199603000-00003

13. Tang NK, Wright KJ, Salkovskis PM. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res. 2007 Mar;16(1):85-95. doi: 10.1111/j.1365-2869.2007.00571.x

14. Bahouq H, Allali F, Rkain H, et al. Prevalence and severity of insomnia in chronic low back pain patients. Rheumatol Int. 2013 May;33(5):1277-81. doi: 10.1007/s00296-012-2550-x. Epub 2012 Nov 5.

15. Abbasi M, Kazemifar AM, Fatorechi H, Yazdi Z. Sleep quality, quality of life and insomnia among patients with chronic low back pain compared to normal individuals. Sleep Hypnos J Clin Neurosci Psychopathol. 2018;20(3):184-9. doi: 10.5350/Sleep.Hypn.2017.19.0151

16. Whibley D, AlKandari N, Kristensen K, et al. Sleep and Pain: A Systematic Review of Studies of Mediation. Clin J Pain. 2019 Jun;35(6):544-58. doi: 10.1097/AJP.0000000000000697

17. Ho KKN, Ferreira PH, Pinheiro MB, et al. Sleep interventions for osteoarthritis and spinal pain: a systematic review and meta-analysis of randomized controlled trials. Osteoarthrtritis Cartilage. 2019 Feb;27(2):196-218. doi: 10.1016/j.joca.2018.09.014. Epub 2018 Oct 18.

18. Qaseem A, Kansagara D, Forciea MA, et al; Clinical Guidelines Committee of the American College of Physicians. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016 Jul 19;165(2):125-33. doi: 10.7326/M15-2175. Epub 2016 May 3.

19. Hood HK, Rogojanski J, Moss TG. Cognitive-behavioral therapy for chronic insomnia. Curr Treat Options Neurol. 2014 Dec;16(12):321. doi: 10.1007/s11940-014-0321-6

20. Drake CL, Kalmbach DA, Arnedt JT, et al. Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep. 2019 Feb 1;42(2):zsy217. doi: 10.1093/sleep/zsy217

21. Epstein DR, Sidani S, Bootzin RR, Belyea MJ. Dismantling multicomponent behavioral treatment for insomnia in older adults: a randomized controlled trial. Sleep. 2012 Jun 1;35(6):797-805. doi: 10.5665/sleep.1878

22. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015 Feb 18;350:h444. doi: 10.1136/bmj.h444

23. Nijs J, Mairesse O, Neu D, et al. Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Phys Ther. 2018 May 1;98(5):325-35. doi: 10.1093/ptj/pzy020

24. Wang HY, Fu TS, Hsu SC, Hung CI. Association of depression with sleep quality might be greater than that of pain intensity among outpatients with chronic low back pain. Neuropsychiatr Dis Treat. 2016 Aug 9;12:1993-8. doi: 10.2147/NDT.S110162

25. Pigeon WR, Moynihan J, Matteson-Rusby S, et al. Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: a pilot study. Behav Res Ther. 2012 Nov;50(11):685-9. doi: 10.1016/j.brat.2012.07.005

26. Tang NK, Goodchild CE, Salkovskis PM. Hybrid cognitive-behaviour therapy for individuals with insomnia and chronic pain: a pilot randomised controlled trial. Behav Res Ther. 2012 Dec;50(12):814-21. doi: 10.1016/j.brat.2012.08.006

27. Malfliet A, Kregel J, Coppieters I, et al. Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial. JAMA Neurol. 2018 Jul 1;75(7):808-17. doi: 10.1001/jamaneurol.2018.0492

28. Malfliet A, Bilterys T, van Looveren E, et al. The added value of cognitive behavioral therapy for insomnia to current best evidence physical therapy for chronic spinal pain: protocol of a randomized controlled clinical trial. Braz J Phys Ther. 2019 Jan-Feb;23(1):62-70. doi: 10.1016/j.bjpt.2018.10.007


For citation:


Lamkova I.A., Parfenov V.A. Insomnia in chronic non-specific low back pain. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(5):62-67. (In Russ.) https://doi.org/10.14412/2074-2711-2021-5-62-67

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)