Investigation of sleep disturbance in chronic low back pain: An age- and gender-matched case-control study over a 7-night period

Preferences and Avoidance of Sleeping Positions Among Patients With Chronic Low Back Pain: A Cross-Sectional Study

Background Chronic low back pain (CLBP) is a common issue among the working-age population. Sleeping position may affect CLBP, with the prone position commonly suggested to be avoided. This study aims to examine the relationship between preferred and avoided sleeping positions and to explore the frequency of increased pain in various sleeping positions among patients with nonspecific CLBP and pain and disability levels. Methods This cross-sectional study included all adult patients referred for specialist consultation for CLBP at the outpatient clinic of the Central Hospital of Central Finland's spine department. Pain intensity was measured using a visual analog scale (VAS), and disability was assessed with the Oswestry Disability Index (ODI). Patients completed a questionnaire detailing the main sleeping positions and positions avoided due to low back pain (LBP). Results The study enrolled 375 consecutive patients, with a mean age of 51 ± 17 years; 64% (n=240) were female. The mean VAS score was 63 ± 24, and the mean Oswestry Index was 38 ± 18%. The majority of patients (87%, n=327) reported sleeping in a side-lying position, followed by supine (47%, n=176) and prone (22%, n=82) positions. A negative correlation was found between age and the preference for sleeping in the prone position. No significant gender differences in sleep positions were observed (p=0.69). Sleep was disturbed in 77% of patients (n=289) due to LBP, and 87% (n=327) reported difficulties due to LBP when getting up. Overall, 92% of participants (n=345) experienced difficulties sleeping or getting up in the morning due to LBP. Many patients avoided certain positions due to pain: 42% (n=157) avoided the prone position, 35% (n=131) the back, 15% (n=56) the left side, and 13% (n=49) the right side. Although the prone position was most commonly linked with pain, especially among women, our findings suggest that any sleeping position could potentially exacerbate pain in individuals with CLBP. Conclusions This study highlights the variability in how sleeping positions affect pain in patients with nonspecific CLBP. While the prone position is most frequently associated with increased pain, individual preferences and responses vary significantly, and often sidelying and supine positions provoke pain. The diversity in sleeping positions that exacerbate pain highlights the need for tailored advice in the management of patients with CLBP.

To what degree patient-reported symptoms of central sensitization, kinesiophobia, disability, sleep, and life quality associated with 24-h heart rate variability and actigraphy measurements?

OBJECTIVES

Chronic musculoskeletal pain is associated with decreased parasympathetic and increased sympathetic activity in the autonomic nervous system. The objective of this study was to determine the associations between objective measures of heart rate variability (a measure of autonomic nervous system function), actigraphy (a measure of activity and sleep quality), respiration rates, and subjective patient-reported outcome measures (PROMs) of central sensitization, kinesiophobia, disability, the effect of pain on sleep, and life quality.

METHODS

Thirty-eight study subjects were divided into two subgroups, including low symptoms of central sensitization (n = 18) and high symptoms of central sensitization (n = 20), based on patient-reported scores on the Central Sensitization Inventory (CSI). Heart rate variability (HRV) and actigraphy measurements were carried out simultaneously in 24 h measurement during wakefulness and sleep.

RESULTS

A decrease in HRV during the first 2 h of sleep was stronger in the low CSI subgroup compared to the high CSI subgroup. Otherwise, all other HRV and actigraphy parameters and subjective measures of central sensitization, disability, kinesiophobia, the effect of pain on sleep, and quality of life showed only little associations.

DISCUSSION

The high CSI subgroup reported significantly more severe symptoms of disability, kinesiophobia, sleep, and quality of life compared to the low CSI subgroup. However, there were only small and nonsignificant trend in increased sympathetic nervous system activity and poorer sleep quality on the high central sensitization subgroup. Moreover, very little differences in respiratory rates were found between the groups.

Musculoskeletal physiotherapy and perceptions on lifestyle interventions: A review

Musculoskeletal pain treatments are widespread in the clinical practice of physiotherapists. A multifaceted biopsychosocial approach should guide modern pain therapy. The study aimed to investigate the association of musculoskeletal problems with lifestyle behaviors. The study adopted a qualitative literature review methodology. About 200 papers have been reviewed for this study. The categories of the study had been classified according to the factors that are interconnected to the life intervention. The inclusion criteria of the selected literature depend upon the data received. This is a review-based study. The results of cross-sectional and correlational analysis dominated the literature on lifestyle implications on musculoskeletal health, which included pain and its correlated inflammation. Long-term prospective studies, however, are difficult to enroll in due to ethical concerns about denying patients' therapies shown to benefit them, notably lifestyle behavior modification. By conducting intervention studies, it determines lifestyle modifications that determine the beneficial aspects. These aspects are avoiding and reducing pain by increasing exercise capacity. The study concluded that the quantity of beneficial health practices boosted the health-related quality of life. To achieve long-term health, the complexity of the behaviour change needs to be supported by the individual's lifestyle pattern and the support of the data. Therefore, in this century characterized by chronic lifestyle-related illnesses, various health behavior modifications may be claimed to be a primary therapeutic skill of health professionals (individually and collectively).

Pressure Pain Thresholds and Central Sensitization in Relation to Psychosocial Predictors of Chronicity in Low Back Pain

(1) Background: Peripheral, as well as central, sensitization have been described in chronic low back pain (cLBP). The purpose of this study is to investigate the influence of psychosocial factors on the development of central sensitization. (2) Methods: This prospective study investigated local and peripheral pressure pain thresholds and their dependence on psychosocial risk factors in patients with cLBP receiving inpatient multimodal pain therapy. Psychosocial factors were assessed using the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). (3) Results: A total of 90 patients were included in the study, 61 (75.4% women, 24.6% men) of whom had significant psychosocial risk factors. The control group consisted of 29 patients (62.1% women, 37.9% men). At baseline, patients with psychosocial risk factors showed significantly lower local and peripheral pressure pain thresholds, suggesting central sensitization, compared to the control group. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), was also correlated with altered PPTs. After multimodal therapy, all participants reported increased local pain thresholds compared to at admission, independent of psychosocial chronification factors. (4) Conclusions: Psychosocial chronicity factors measured using the ÖMPSQ have a significant influence on pain sensitization in cLBP. A 14-day multimodal pain therapy increased local, but not peripheral, pressure pain thresholds.

Effects of non-pharmacological interventions on sleep in chronic low back pain: A systematic review and meta-analysis of randomised controlled trials

Low back pain is a leading cause of disability worldwide and adults with chronic low back pain (≥12weeks) commonly experience sleep impairments (e.g., insomnia, sleep disturbance). This study examined the effects of non-pharmacological interventions on sleep in adults with chronic low back pain. Six databases (PubMed, CINAHL, SPORTDiscus, PsycINFO, EMBASE, CENTRAL) were searched from inception to 2 June 2021 for randomised controlled trials. Pairwise random-effect meta-analysis estimated standardised mean difference (Hedges' g) at end-of-intervention follow-up. Nineteen studies (participants: 1348) were included. When compared to control, non-pharmacological interventions improved sleep (g [95%CI]: -0.33 [-0.56, -0.11], p = 0.004, small effect, I² = 59.3%; n = 879; studies: n = 13; GRADE: low). This small improvement in sleep was associated with a moderate reduction in pain intensity (-0.69 [-1.00, -0.38], p < 0.001, I² = 75.3%; n = 812; studies: n = 12; GRADE: very low) and no changes in back-related disability (-0.50 [-1.13, 0.14], p = 0.129, I² = 91.4%; n = 517; studies: n = 6; GRADE: low). Notably, all eligible studies reported interventions primarily aimed to reduce pain, although our search criteria were not limited to pain interventions. Key limitations were data paucity and high risk of bias. Future research should investigate sleep-based interventions (i.e., those purposely designed to improve sleep) using subjective and objective measures across a range of sleep domains (CRD42021275227).

Effects of Tai Chi on insomnia in elderly people with chronic non-specific low back pain: A study protocol for a randomized controlled trial

Introduction

Chronic non-specific low back pain (CNLBP) is a complex condition characterized by pain, dysfunction, disturbed sleep, anxiety, and depression, all of which impair the quality of life. Previous studies showed that practicing Tai Chi had effects on chronic low back pain. However, there is a lack of evidence on its impact on sleep. The trial will evaluate the use of Tai Chi as a treatment for insomnia in elderly people with CNLBP.

Methods

The study design will be a randomized, controlled, open-label trial. Participants (n = 106) will be recruited from the Hospital of Chengdu University of Traditional Chinese Medicine, Qing Yang District University for the Elderly, and Ci Tang Street Community. Participants will be randomly assigned to the Tai Chi group (n = 53) and the control group (n = 53). The Tai Chi group will undergo a Yang-style 24-form Tai Chi program for 8 weeks. The control group will have a waiting period of 8 weeks, followed by 8 weeks of Tai Chi practice. The primary outcomes of this study will be changes in sleep quality and pain intensity. Secondary outcomes of interest will include changes in the quality of pain, range of motion, physical performance, social support, and overall quality of life. Any adverse events and attendance rates will also be reported in this study.

Clinical trial registration

ChiCTR2200064977.

Low back pain is associated with sleep disturbance: a 3-year longitudinal study after the Great East Japan Earthquake

BACKGROUND

Low back pain and sleep disturbance are common health problems worldwide which are also commonly observed among people after natural disasters. These symptoms are well known to coexist, and recent reports have indicated that sleep disturbance is a risk factor for low back pain. However, the influence of low back pain on sleep disturbance has rarely been assessed; therefore, this study aimed to clarify the association of low back pain with sleep disturbance, especially focusing on the frequency of low back pain, using 3-year cohort data after the Great East Japan Earthquake.

METHODS

This study used the data obtained from people living in the disaster-affected areas after the Great East Japan Earthquake (n = 2,097). Low back pain and sleep disturbance were assessed at 4, 5, 6, and 7 years after the disaster. The frequency of low back pain was defined as the number of low back pain episodes at and before the evaluation time point and categorized into five groups such as absence, 1, 2, 3, and 4 at the fourth time point and four groups such as absence, 1, 2, and 3 at the third time point. Multivariate logistic regression analyses were conducted to assess the association of low back pain with sleep disturbance.

RESULTS

Low back pain was significantly associated with sleep disturbance, and the association was stronger in participants with more frequent low back pain (adjusted odds ratios [95% confidence intervals],1.46 [1.10-1.95] in "1"; 2.02 [1.49-2.74] in "2"; 2.38 [1.67-3.40] in "3"; and 4.08 [2.74-6.06] in "4" in the frequency of low back pain) (P for trend < 0.001). Furthermore, antecedent low back pain was significantly associated with new-onset sleep disturbance, and the association was robust in more frequent low back pain (adjusted odds ratios [95% confidence intervals],1.60 [1.05-2.44] in "1"; 1.96 [1.20-3.21] in "2"; and 2.17 [1.14-4.14] in "3" in the frequency of low back pain) (P for trend = 0.007).

CONCLUSION

Our study showed that low back pain is strongly associated with sleep disturbance. Attention should be paid to low back pain to prevent and treat sleep disturbance, especially focusing on chronicity of low back pain.

Causal association of sleep disturbances and low back pain: A bidirectional two-sample Mendelian randomization study

BACKGROUND

Previous observational studies have shown that low back pain (LBP) often coexists with sleep disturbances, however, the causal relationship remains unclear. In the present study, the causal relationship between sleep disturbances and LBP was investigated and the importance of sleep improvement in the comprehensive management of LBP was emphasized.

METHODS

Genetic variants were extracted as instrumental variables (IVs) from the genome-wide association study (GWAS) of insomnia, sleep duration, short sleep duration, long sleep duration, and daytime sleepiness. Information regarding genetic variants in LBP was selected from a GWAS dataset and included 13,178 cases and 164,682 controls. MR-Egger, weighted median, inverse-variance weighted (IVW), penalized weighted median, and maximum likelihood (ML) were applied to assess the causal effects. Cochran's Q test and MR-Egger intercept were performed to estimate the heterogeneity and horizontal pleiotropy, respectively. Outliers were identified and eliminated based on MR-PRESSO analysis to reduce the effect of horizontal pleiotropy on the results. Removing each genetic variant using the leave-one-out analysis can help evaluate the stability of results. Finally, the reverse causal inference involving five sleep traits was implemented.

RESULTS

A causal relationship was observed between insomnia-LBP (OR = 1.954, 95% CI: 1.119-3.411), LBP-daytime sleepiness (OR = 1.011, 95% CI: 1.004-1.017), and LBP-insomnia (OR = 1.015, 95% CI: 1.004-1.026), however, the results of bidirectional MR analysis between other sleep traits and LBP were negative. The results of most heterogeneity tests were stable and specific evidence was not found to support the disturbance of horizontal multiplicity. Only one outlier was identified based on MR-PRESSO analysis.

CONCLUSION

The main results of our research showed a potential bidirectional causal association of genetically predicted insomnia with LBP. Sleep improvement may be important in comprehensive management of LBP.

Perceptions of practising physiotherapists in Saudi Arabia about their role in the health promotion of patients with musculoskeletal conditions: a qualitative study

OBJECTIVE

This study aimed to explore physiotherapists' perceptions in Saudi Arabia about their understanding and role in health promotion through lifestyle behaviours and risk factors assessment and management of patients with musculoskeletal pain and disabilities.

STUDY DESIGN

Qualitative study.

METHOD

One-to-one interviews with 12 physiotherapists (six females; mean age 34.5 ± 8) within a constructivist framework. Interviews were recorded, transcribed verbatim, and analysed using a thematic analysis approach.

RESULT

Three themes were identified: (1) the physiotherapists' awareness and knowledge of health promotion; (2) current practice of physiotherapists to implementing health promotion practice; and (3) the physiotherapists' perceived barriers to implementing health promotion practice. Participants generally perceived health promotion to be within their scope of practice. However, their understanding and approaches to deliver this practice were varied and non-standardised. Some barriers to routine engagement in health promotion were identified, including time constraints, the beliefs of healthcare practitioners, and limited education and training.

CONCLUSION

This study highlighted that physiotherapists acknowledged the role of health promotion in their practice. However, there were different explanations of the concept and it was informally practised.

Association Between Sleep Disturbance and Low Back Pain: A 3-Year Longitudinal Study After the Great East Japan Earthquake

STUDY DESIGN

A longitudinal study.

OBJECTIVE

The aim of this study was to clarify the association between sleep disturbance and low back pain (LBP) using 3-year longitudinal data after the Great East Japan Earthquake, with a focus on the duration or frequency of sleep disturbance and the effect of sleep disturbance on LBP.

SUMMARY OF BACKGROUND DATA

Sleep disturbance and LBP are common health problems in the general population and natural disaster survivors. However, a longitudinal study in this field is rare, and the association between sleep disturbance and LBP has not been clarified.

METHODS

A 3-year longitudinal study was conducted among people living in disaster-stricken areas after the Great East Japan Earthquake (n = 2059). Sleep disturbance and LBP were assessed at 4, 5, 6, and 7 years after the disaster. Multiple logistic regression analysis was performed to assess the association between the duration or frequency of sleep disturbance and LBP, and the effect of preceding sleep disturbance on the onset of LBP. The χ2 test and crude and multiple logistic regression models were used in data analysis.

RESULTS

The duration and frequency of sleep disturbance were significantly associated with LBP, and the effect was stronger with longer duration and increased frequency of sleep disturbance. Furthermore, the duration and frequency of preceding sleep disturbance were significantly associated with the onset of LBP, and the effect was stronger with an increase in the duration and frequency of sleep disturbance.

CONCLUSION

Sleep disturbance is associated with LBP in a dose-dependent manner. Attention should be paid to sleep disturbance for the treatment and prevention of LBP, especially with regard to the duration and frequency of sleep disturbance.Level of Evidence: 3.

Association of insomnia and daytime sleepiness with low back pain: A bidirectional mendelian randomization analysis

Purpose: Observational research has indicated the presence of a causal relationship between sleep disturbances and low back pain (LBP). However, the link may have been biased by confounding factors. The purpose of this study was to examine the potential causal association of insomnia and daytime sleepiness with LBP by using mendelian randomization (MR). Methods: Genome-wide association study (GWAS) summary statistics of insomnia were obtained from a large-scale GWAS meta-analysis (n = 1,331,010; individuals from UK Biobank and 23andMe) or UK Biobank alone (n = 453,379). The summary statistics of daytime sleepiness were from UK Biobank (n = 452,071) and LBP were provided by the FinnGen Release 6 (210,645 individuals with 16,356 LBP cases and 194,289 controls) or UK Biobank (5,423 cases versus 355,771 controls). Linkage disequilibrium score (LDSC) regression and bidirectional MR analysis was employed to estimate genetic correlation and causal relationship. In the MR analysis, the inverse variance weighted method (IVW) was utilized as the main analysis procedure, while MR-Egger, Weighted median and Robust adjusted profile score (RAPS) were utilized for supplementary analyses. Results: LDSC analysis showed that LBP were significantly genetically correlated with insomnia (rg = 0.57, p = 2.26e-25) and daytime sleepiness (rg = 0.18, p = 0.001). The MR analysis revealed that genetically predicted insomnia was significantly associated with an increased risk of LBP (OR = 1.250, 95% CI: 1.186-1.318; p = 1.69e-16). However, the reverse causality was not confirmed. No evidence was identified supporting causality of daytime sleepiness and LBP. Conclusion: This study demonstrates a putative causal link of insomnia on LBP and a null causal effect of LBP on insomnia. Furthermore, a causal link between daytime sleepiness and LBP were not reported. This finding may stimulate new strategies for patient management in clinical practice, benefiting public health.

The Effect of Sleep Quality on Pain in Chilean Individuals with Musculoskeletal Disorders

Poor sleep quality (SQ) negatively affects pain associated with musculoskeletal disorders (MSD). As the level of economic development of a country determines its sanitary conditions, these can influence the sleep–pain relationship; therefore, it is relevant to generate evidence in the population with MSD in developing countries. This cross-sectional study sought to determine the effect of poor SQ on pain in Chilean individuals with MSD, controlling for sex and duration of pain (in months). Method: A total of 228 individuals were included. SQ was measured with the Pittsburg Sleep Quality Index (PSQI), pain (intensity, interference and distress relative to pain) was measured with visual analog scales. Structural equation modeling (SEM) was performed to analyze the effect of SQ on pain. Results: A high frequency of poor SQ was present in the studied group, and was more prevalent in women. The SEM model evidenced that poor SQ predicts greater pain. Sex influences sleep quality and pain, but not pain duration. Conclusions: These findings indicate that poor SQ predicts higher pain in MSD and that women exhibit worse SQ and more significant pain than men. Our findings support that SQ should be considered in the comprehensive approach to pain in individuals with MSD.

Cross-Cultural Adaptation, Reliability, and Psychophysical Validation of the Pain and Sleep Questionnaire Three-Item Index in Finnish

Reciprocal relationships between chronic musculoskeletal pain and various sleep disturbances are well established. The Pain and Sleep Questionnaire three-item index (PSQ-3) is a concise, valid, and reliable patient-reported outcome measure (PROM) that directly evaluates how sleep is affected by chronic low back pain (CLBP). Translation and cross-cultural validation of The Pain and Sleep Questionnaire three-item index Finnish version (PSQ-3-FI) were conducted according to established guidelines. The validation sample was 229 subjects, including 42 pain-free controls and 187 subjects with chronic musculoskeletal pain. Our aims were to evaluate internal consistency, test-retest reliability, measurement error, structural validity, convergent validity, and discriminative validity and, furthermore, to study the relationships between dizziness, postural control on a force plate, and objective sleep quality metrics and total PSQ-3-FI score. The PSQ-3-FI demonstrated good internal consistency, excellent test-retest reliability, and small measurement error. Confirmatory factor analysis confirmed acceptable fit indices to a one-factor model. Convergent validity indicated fair to good correlation with pain history and well-established pain-related PROMs. The PSQ-3-FI total score successfully distinguished between the groups with no pain, single-site pain, and multisite pain. A higher prevalence of dizziness, more impaired postural control, and a general trend towards poorer sleep quality were observed among subjects with higher PSQ-3-FI scores. Postural control instability was more evident in eyes-open tests. The Finnish PSQ-3 translation was successfully cross-culturally adapted and validated. The PSQ-3-FI appears to be a valid and reliable PROM for the Finnish-speaking CLBP population. More widespread implementation of PSQ-3 would lead to better understanding of the direct effects of pain on sleep.

Low back pain and its correlations with poor sleep quality among health care providers

Objective

Methods

Results

Conclusion

Epidemiology of chronic back pain among adults and elderly from Southern Brazil: a cross-sectional study

BACKGROUND

Chronic back pain (CBP) can negatively affect one's quality of life and health condition, posing significant social and economic burdens.

OBJECTIVES

(1) To determine the prevalence of CBP and analyze associated factors in adult and elderly individuals in a municipality in southern Brazil; (2) to verify who sought medical attention or missed work because of back pain; and (3) to estimate the impact of CBP on selected health outcomes.

METHODS

This was a population-based cross-sectional study conducted with individuals aged 18 years and older. CBP was defined as "pain for three consecutive months in the cervical, thoracic, or lumbar regions in the last year." Demographic, socioeconomic, behavioral, and physical and mental health information was collected. The impact of CBP was assessed by the etiological fraction method.

RESULTS

The prevalence of CBP was 20.7% (95% CI: 18.3, 23.0) among the 1300 study participants. The factors associated with CBP were women, elderly, smokers, obesity, and sleeping fewer hours per night, as well as those with higher mental stress levels, history of fracture, arthritis/rheumatism, and work-related musculoskeletal disorder/repetitive strain injury. One-third of those with CBP missed work (31%) and 68% visited the physician over a 12-month period. All health outcomes analyzed (poor or very poor sleep quality, regular or poor health perception, worsened quality of life, depressive symptoms, perceived sadness) were significantly associated with CBP.

CONCLUSION

One in five adults or elderly reported having CBP over the previous 12 months. This condition was associated with poorer health perception, poorer quality of life, and depressive symptoms.

Sleep quality and chronic neck pain: a cotwin study

STUDY OBJECTIVES

Sleep quality and chronic neck pain (NP) are associated. However, the genetic influences on this association have not been explored. This study investigated the genetic and environmental influences on the association between sleep quality and chronic NP.

METHODS

The sample comprised 2,328 individual twins from the Murcia Twin Registry (Spain). A bidirectional cotwin logistic regression analysis was performed (sleep quality assessed as the exposure and chronic NP as the outcome and vice versa). Analysis included 2 sequential stages: total sample analysis and within-pair twin case-control analysis.

RESULTS

Sleep quality was significantly associated with chronic NP in the total sample analysis (adjusted odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.06, 1.12; P < .001); in the cotwin case-control analysis, including both monozygotic and dizygotic twin pairs (adjusted OR: 1.10; 95% CI: 1.04, 1.17; P = .001); in dizygotic pairs (Adjusted OR: 1.11; 95% CI: 1.03, 1.19; P = .005); but not in monozygotic pairs (adjusted OR: 1.08; 95% CI: 0.98, 1.19; P = .118). Chronic NP was significantly associated with poor sleep quality in the total sample analysis (adjusted OR: 1.80; 95% CI: 1.43, 2.26; P < .001); in the cotwin case-control analysis, including both monozygotic and dizygotic twin pairs (Adjusted OR: 1.63; 95% CI: 1.07, 2.47; P = .023); in dizygotic pairs (Adjusted OR: 1.80; 95% CI: 1.05, 3.09; P = .031), but not in monozygotic pairs (adjusted OR: 1.67; 95% CI: 0.80, 3.48; P = .170).

CONCLUSIONS

The association between sleep quality and chronic NP is partially confounded by genetic factors.

Occupational Characteristics of Low Back Pain Among Standing Workers in a Japanese Manufacturing Company

Low back pain (LBP) is a major public health problem that adversely affects the quality of life (QOL) of workers. The etiology of LBP is considered to be multi-factorial with individual, physical, and psychosocial factors contributing to its development and persistence. Although prevention of LBP in workers in the workplace is very important, only a small number of studies have assessed the risk factors and epidemiology of LBP among Japanese factory workers who stand as part of their job. This cross-sectional study investigated the prevalence of LBP in 691 factory employees who conducted their work while standing. Health-related QOL was evaluated using the Roland-Morris Disability Questionnaire (RDQ) to quantify the severity of LBP with the aim of identifying risk factors for LBP among workers who stand as part of their work in an electronics manufacturing company. We observed that the prevalence of LBP lasting for at least 48 hours within a week was 20.0% among participants, with female employees and those with a prior history of LBP having a significantly increased risk of developing LBP. The distribution of the RDQ score showed a negative regression curve among the employees, which was different from the normal distribution pattern reported previously in Japanese patients with LBP. These findings suggest that prolonged standing among factory workers poses an increased risk for LBP.

Impact of transcutaneous electrical nerve stimulation on sleep in chronic low back pain: a real-world retrospective cohort study

Objective

The purpose of this study was to determine if transcutaneous electrical nerve stimulation (TENS) improves sleep in chronic low back pain (CLBP).

Background

There is uncertainty over the effectiveness of TENS in CLBP. In most studies, pain intensity has been the primary outcome measure. Although sleep abnormalities are common in CLBP, sleep outcomes have not been evaluated in most studies of TENS effectiveness. Subjective and objective sleep measures are often inconsistent in CLBP, suggesting that perception of sleep and actual sleep may differ.

Methods

This retrospective cohort study evaluated TENS for CLBP over 10 weeks. The source database included demographics, pain characteristics, pain intensity and interference on an 11-point numerical rating scale, adherence and actigraphic sleep data from real-world TENS users. Key inclusion criteria were CLBP with self-reported history of back injury and baseline pain interference with sleep ≥4. Study participants were stratified into improved and unimproved groups based on changes in pain interference with sleep (improved ≥1-point decrease). Actigraphic sleep metrics were compared between the two groups for weeks 1–2 and weeks 9–10.

Results

The inclusion criteria were met by 554 TENS users. There were 282 (50.9%) participants in the improved group and 272 (49.1%) in the unimproved group. The two groups had similar baseline characteristics and high TENS adherence. At the weeks 1–2 assessment, there were no differences among actigraphic sleep. At the weeks 9–10 assessment, there was a difference in total sleep time, with the improved group sleeping 29 minutes longer. In addition, the periodic leg movement (PLM) index was lower in the improved group.

Conclusion

Regular TENS improved self-reported and objective sleep measures in individuals with CLBP. When compared to the unimproved group, the improved group had longer total sleep time and fewer PLMs. Sleep may be an important outcome for TENS effectiveness in CLBP.

The effect of stabilization exercise on pain-related disability, sleep disturbance, and psychological status of patients with non-specific chronic low back pain

Background

Sleep disturbance and depression are becoming more recognized as important symptoms among individuals with chronic low back pain. This study evaluated the effect of stabilization exercise on pain-related disability, sleep disturbance and the psychological status of patients with non-specific chronic low back pain (NSCLBP).

Methods

A total of 26 patients (M/F = 17/9) with NSCLBP with a mean age of 50.0 ± 15.5 took part in this study. Participants were recruited from selected hospitals in Lagos state. Ethical approval was sought and obtained from the health research and ethics committee of Lagos University Teaching Hospital Idi-araba, Lagos, Nigeria. Participants performed stabilization exercise for eight weeks consecutively and were assessed for pain-related disability, anxiety, depression, and sleep disturbance using the pain-disability index, hospital anxiety and depression scale, and the insomnia severity index at baseline, the 4th week, and the 8th week, post-intervention.

Results

The participants studied recorded significant reduction in pain-related disability (P = 0.001). There was also improvement in the sleep quality (P = 0.001), depression level (P = 0.001), and anxiety level (P = 0.001), post intervention.

Conclusions

This study revealed that stabilization exercise is very useful in the management of sleep disturbance, pain-related disability, depression, and anxiety in NSCLBP patients.

Is the Self-Reporting of Failed Back Surgery Syndrome Patients Treated With Spinal Cord Stimulation in Line With Objective Measurements?

OBJECTIVES

To understand the subjective pain experience of patients, healthcare providers rely heavily on self-reporting. However, to quantify this unique pain experience, objective parameters are not yet available in daily clinical practice. With regard to patients with failed back surgery syndrome (FBSS) treated with spinal cord stimulation (SCS), pain therapists may recover the individual functional information about the patient's posture from the implantable pulse generator (IPG) of the stimulator. The aim of this study is to investigate whether subjective self-reporting is in correlation with the functional capacities of a patient.

MATERIALS AND METHODS

Thirty-nine patients with FBSS, treated with SCS were included. The accelerometer in the IPG detects positional changes and provides an objective output of seven functional positions (lying back, lying prone, lying left, lying right, transition, upright, and upright + mobile). The Oswestry Disability Index (ODI), VAS-diary, and the Pittsburgh Sleep Quality Index (PSQI) were assessed to evaluate physical functioning, pain intensities, and subjective sleep quality. Additionally, 21 patients wore a wearable actigraph device to objectify sleep quality. The agreement and Spearman correlations between objective and subjective parameters were assessed.

RESULTS

Spearman rank correlations revealed no significant correlations between the ODI (subscales walking, sitting, standing, and sleeping) and the output of the IPG (percentage upright + mobile, transition, upright, and lying, respectively). Sleep parameters measured with the Actiwatch and the PSQI were not in agreement.

CONCLUSIONS

This study demonstrated that self-reporting questionnaires do not correlate with the findings of objective measurements. Therefore, we recommend using both subjective and objective parameters when determining treatment options for FBSS patients.

Understanding Monitoring Technologies for Adults With Pain: Systematic Literature Review

BACKGROUND

Monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, monitoring patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain; however, no previous study has reviewed the contextual information that a monitoring system may capture to characterize a patient's situation.

OBJECTIVE

The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adults with pain, and (2) construct a model of the context information that may be used to implement apps and devices aimed at monitoring adults with pain.

METHODS

A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore) using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article.

RESULTS

In the final analysis, 87 articles were included and 53 of them (61%) used technologies to collect contextual information. A total of 49 types of context information were found and a five-dimension (activity, identity, wellness, environment, physiological) model of context information to monitor adults with pain was proposed, expanding on a previous model. Most technological interfaces for pain monitoring were wearable, possibly because they can be used in more realistic contexts. Few studies focused on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy.

CONCLUSIONS

The design of monitoring devices and interfaces for adults with pain must deal with the challenge of selecting relevant contextual information to understand the user's situation, and not overburdening or inconveniencing users with information requests. A model of contextual information may be used by researchers to choose possible contextual information that may be monitored during studies on adults with pain.

Does physical activity buffer insomnia due to back and neck pain?

INTRODUCTION

Musculoskeletal pain is highly prevalent and a burden to society, recurrent and persistent low back pain (LBP) and neck pain (NP) being the most common conditions. They are associated with other poor health outcomes such as sleep problems. Physical activity (PA) prevents LBP and NP, but the direct effect on sleep is unclear. This study explored the effect of pain on insomnia, and examined if adherence to moderate-to-high intensity levels of PA influenced this relationship.

METHODS

In this prospective observational study, 1821 workers were followed over 3 years. Data included self-rated measures of LBP and NP, insomnia and level and amount of PA. Pain variables were used in a "risk profile" for future sick-listing, insomnia was categorized into those with and without such problems, and adherence to PA was defined as reporting moderate-to-high levels in two consecutive years. In Poisson regression models, individuals with pain risk profiles were analysed according to PA adherence for the outcome insomnia. Repeated measurements allowed control for prior pain.

RESULTS

In this mainly male working population, individuals with a risk profile for LBP and NP had a significant increased risk (RR = 1.5) of developing insomnia one year later when not adhering to moderate-to-high levels of PA. Among those not reporting prior pain, the risk was even larger (RR = 2.5). Generalizability may be restricted to relatively healthy males. The individuals who reported a pain risk profile two consecutive years did not get the buffer effect from adhering to moderate-to-high levels of PA in terms of developing insomnia.

The association between sleep quality, low back pain and disability: A prospective study in routine practice

BACKGROUND

The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice.

METHODS

This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period.

RESULTS

Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]).

CONCLUSIONS

Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability.

SIGNIFICANCE

In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

Sleep quality during pregnancy: A meta-analysis

Women's sleep quality has been reported to change during pregnancy; prevalence estimates of poor sleep quality during pregnancy vary widely. To further understand the observed variation of findings, we conducted a meta-analysis to quantify the prevalence of poor sleep quality during pregnancy. Articles (N = 24) that reported prevalence of poor sleep quality as captured by the Pittsburgh sleep quality index (PSQI) ≥ 5 were included, with a total of 11,002 participants contributing data. PubMed, PsycINFO, and Web of Science databases were systematically searched. Results indicated that the average PSQI score during pregnancy was 6.07, 95% confidence interval (CI) [5.30, 6.85], and 45.7%, 95% CI [36.5%, 55.2%], of pregnant women experienced poor sleep quality. Longitudinal studies indicated that sleep quality decreased from second (M = 5.31, SE = 0.40) to third trimester (M = 7.03, SE = 0.85) by 1.68 points, 95% CI [0.42, 2.94]. Gestational age moderated the average PSQI scores and prevalence of PSQI scores ≥5; older samples reported higher mean PSQI scores and higher prevalence of poor sleep quality. Clinicians should be aware that some reduction in sleep quality is expected during pregnancy, but complaints of very poor sleep quality could require intervention. Future research should examine various factors underlying poor sleep quality during pregnancy.

Reference values and factors associated with musculoskeletal symptoms in healthy adolescents and adults

BACKGROUND

Insufficient attention has been given to individuals who report musculoskeletal symptoms yet experience minimal disability.

OBJECTIVES

To examine musculoskeletal symptoms among healthy individuals, and compare demographic, psychological and physical factors between individuals with and without symptoms.

DESIGN

Cross-sectional observational study.

METHOD

Data were from the 1000 Norms Project which recruited 1000 individuals aged 3-101 years. Participants were healthy by self-report and had no major physical disability. Musculoskeletal symptoms (ache/pain/discomfort, including single-site and multi-site symptoms) were assessed in adolescents (11-17y) and adults (18-101y) using the Extended Nordic Musculoskeletal Questionnaire (NMQ-E). To compare individuals with single-site, multi-site and no symptoms, body mass index, grip strength, 6-min walk, 30-s chair stand and timed up-and-down stairs (all participants), and mental health, sleep difficulties, self-efficacy and physical activity (adults), were collected.

RESULTS

/findings: Socio-demographic characteristics were similar to the Australian population. Twelve-month period prevalence of all symptoms was 69-82%; point prevalence was 23-39%. Adults with single-site symptoms were more likely to be overweight/obese and had lower sit-to-stand and stair-climbing performance (p < 0.05). Adults with multi-site symptoms were more likely to be female and overweight/obese, had lower mental health, greater sleep difficulties and lower grip strength, 6-min walk and sit-to-stand performance (p < 0.05). Differences were only observed among 50-59, 60-69, 70-79 and 80-101 year-olds.

CONCLUSIONS

Normative reference data for the NMQ-E have been generated. Musculoskeletal symptoms are common among healthy individuals. In older adults, musculoskeletal symptoms are linked with overweight/obesity, lower mental health, sleep difficulties and lower physical performance, emphasising the importance of multi-dimensional assessments in musculoskeletal disorders.

Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain

Background

Low back pain (LBP) is the most common problem worldwide. There are several negative consequences of LBP, such as sleep disorders, work leave, disability, depression, anxiety, and poor quality of life. In this study, we designed to evaluate the prevalence of sleep disturbance in patients with non-specific LBP(NSLBP), and cross-correlation among sleep disorder, anxiety, depression and pain intensity in patients with NSLBP.

Aim

In this study, we designed to evaluate the prevalence of sleep disturbance in patients with NSLBP, and cross-correlation among sleep disorder, anxiety, depression and pain intensity in patients with NSLBP.

Methods

A cross-sectional self-assessment questionnaire survey was carried out in an outpatient clinic. Anonymous assessments were used to characterize the presence of NSLBP, PSQI, VAS, SF-36 form, ODI, BAI and BDI. Cross-correlation among the severity of NSLBP and sleep disturbance, anxiety, depression and life quality were evaluated.

Results

Patients with NSLBP have a higher incidence of sleep disorder, anxiety and depression, and higher ODI scores than healthy people without LPB (P < 0.01). NSLBP patients with sleep disorders have more severe anxiety, depression, an increased VAS score and poor daily living (P < 0.05). NSLBP patients with anxiety have declined sleep quality, poor daily living, decreased work and social skills, and increased LBP severity (P < 0.05). NSLBP patients with depression have declined sleep quality, poor daily living, decreased work and social skills (P < 0.05). Significant associations were found between the severity of NSLBP and sleep disorders, anxiety and ODI scores.

Conclusion

Psychological and social factors play an important role in the development of NSLBP. NSLBP leads to sleep disorders, which decrease the sleep quality and increase the unpleasant emotions and memories in return; these can exacerbate the severity of LBP, with the cycle repeating to form a vicious circle.

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain

Background

Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries.

Objective

To determine differences in pain perception between individuals with LBP living in Brazil and Spain.

Method

Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests.

Results

A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group.

Conclusion

The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

Patients with neck pain are less likely to improve if they experience poor sleep quality: a prospective study in routine practice

OBJECTIVE

To assess whether sleep quality (SQ) at baseline is associated with improvement in pain and disability at 3 months.

MATERIALS AND METHODS

Four hundred twenty-two subacute and chronic patients with neck pain (NP) were recruited in 32 physiotherapy, primary care, and specialized centers. NP, referred pain, disability, catastrophizing, depression, and SQ were assessed through validated questionnaires, upon recruitment and 3 months later. Correlations between baseline scores were calculated through the Spearman coefficient. Improvements in NP, disability, and SQ were defined as a reduction of ≥30% of baseline score. Six estimative logistic regression models were developed to assess the association between baseline SQ and improvement of NP, baseline SQ and improvement of disability, baseline NP and improvement of SQ, baseline disability and improvement of SQ, the evolutions of NP and SQ, and the evolutions of disability and SQ.

RESULTS

Most patients were subacute and mildly impaired. Regression models showed that better SQ at baseline was associated with improvement of NP (odds ratio=0.91 [95% confidence interval, 0.83-0.99]), but not disability (1.04 [0.95-1.13]); the improvement of SQ was associated with more severe NP at baseline (1.26 [1.07-1.49)], but not with baseline disability (0.99 [0.97-1.02]); and that improvement in SQ was associated with improvements in NP (3.48 [1.68-7.20]), and disability (5.02 [2.39-10.11]).

DISCUSSION

NP is less likely to improve in patients with poorer SQ, irrespective of age, sex, catastrophizing, depression, or treatments prescribed for NP. Future studies should confirm these results with more severely impaired patients.

Sleep quality in patients with chronic low back pain

Abstract Introduction : Sleep performs a restorative function for the body. Medical conditions such as Chronic Low Back Pain (CLBP) may cause sleep changes and impair sleep quality. Objectives : To identify the prevalence of sleep disorders among individuals with CLBP, and investigate whether there is an association between these disorders and perceived functional disability. Materials and methods : This observational, descriptive study was conducted with 51 patients seen at the Clinic of the School of Physical Therapy of Santa Catarina State University. Data were collected through interviews addressing socio-demographic and clinical data, and administration of the Roland-Morris Disability Questionnaire (RMDQ) and Pittsburgh Sleep Quality Index (PSQI). Results : Participants had high levels of functional disability (mean, 16.71 ± 4.16 score points). 82.35% of patients had poor sleep quality (mean, 10.22 ± 4.84 score points). The PSQI components with the highest mean scores were: sleep latency and sleep disturbances. There was also a weak association between functional disability and sleep quality (Spearman = 0.31; p = 0.025), i.e., the higher the disability, the worse the quality of sleep. Conclusion : We found a high prevalence of sleep disorders among patients with CLBP, and a weak association with the level of perceived disability. It is important to conduct further studies on the relationship between these factors and sleep quality. Moreover, there is a need for a multidisciplinary approach in the treatment of CLBP, in order to treat sleep disorders and improve patients' quality of life.

The bidirectional relationship between pain intensity and sleep disturbance/quality in patients with low back pain

OBJECTIVES

This study investigated the bidirectional relationship between the intensity of low back pain (LBP) and sleep disturbance. Further, the study aimed to determine whether any relationship is dependent on pain duration, symptoms of depression and anxiety, and the method of sleep assessment (subjective vs. objective).

MATERIALS AND METHODS

Eighty patients with LBP completed a sleep diary. A subgroup of 50 patients additionally wore an electronic device (Armband) to measure sleep for 7 consecutive days. Pain intensity was assessed twice daily using a sleep diary. Depression and anxiety symptoms were assessed at baseline using the Depression Anxiety Stress Scale questionnaire. Generalized estimating equations (GEE) with an exchangeable correlation structure were used to examine the relationship between day-time pain intensity and sleep.

RESULTS

The GEE analysis showed that a night of poor sleep quality, difficulty falling sleep (assessed by the sleep diary), waking after sleep onset, and low sleep efficiency (assessed by the sleep diary and Armband) were followed by a day with higher pain intensity. Further, a day with higher pain intensity was associated with a decrease in the subsequent night's sleep quality, an increase in sleep latency (assessed by the sleep diary), waking after sleep onset (assessed by both measures), and low sleep efficiency (assessed by the Armband).

DISCUSSION

The findings demonstrate that there is a bidirectional relationship between sleep and pain intensity in patients with LBP. The relationship is independent of pain duration and baseline symptoms of depression and anxiety and somewhat dependent on the method of sleep measurement (sleep diary or Armband). Future research is needed to determine whether targeting sleep improvement in patients with LBP contributes to pain reduction.

What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain?

Background

Other than activity and exercise, lifestyle practices such as not smoking and healthy nutrition, well established for preventing and managing lifestyle-related non-communicable diseases (i.e., heart disease, cancer, hypertension, stroke, obstructive lung disease, diabetes, and obesity), are less emphasized in the physical therapy guidelines for addressing chronic pain, e.g., back pain. This state-of-the-art review examines the relationships between lifestyle behaviours and musculoskeletal health, with special reference to chronic pain, and their clinical and research implications.

Discussion

A state-of-the-art review was conducted to synthesize evidence related to lifestyle factors (not smoking, healthy diet, healthy weight, optimal sleep and manageable stress, as well as physical activity) and musculoskeletal health, with special reference to chronic pain. The findings support that health behaviour change competencies (examination/assessment and intervention/treatment) may warrant being included in first-line management of chronic pain, either independently or in conjunction with conventional physical therapy interventions. To address knowledge gaps in the literature however three lines of clinical trial research are indicated: 1) to establish the degree to which traditional physical therapy interventions prescribed for chronic pain augment the benefits of lifestyle behaviour change; 2) to establish the degree to which adopting healthier lifestyle practices, avoids or reduces the need for conventional physical therapy; and 3) to establish whether patients/clients with healthier lifestyles and who have chronic pain, respond more favourably to conventional physical therapy interventions than those who have less healthy lifestyles.

Summary

Lifestyle behaviour change is well accepted in addressing lifestyle-related non-communicable diseases. Compelling evidence exists however supporting the need for elucidation of the role of negative lifestyle behaviours on the incidence of chronic pain, and the role of positive lifestyle behaviours on its incidence and effective management. Addressing lifestyle behaviour change in patients/clients with chronic pain, e.g., back pain, as a first-line intervention might not only constitute a novel approach, but also reduce the socioeconomic burden related to chronic pain as well as non-communicable diseases.

Risk factors associated with clinical insomnia in chronic low back pain: a retrospective analysis in a university hospital in Korea

Background

Insomnia is becoming increasingly recognized as a clinically important symptom in patients with chronic low back pain (CLBP). In this retrospective study, we have determined risk factors associated with clinical insomnia in CLBP patients in a university hospital in Korea.

Methods

Data from four-hundred and eighty one CLBP patients was analyzed in this study. The Insomnia Severity Index (ISI) was used to determine the presence of clinical insomnia (ISI score ≥ 15). Patients' demographics and pain-related factors were evaluated by logistic regression analysis to identify risk factors of clinical insomnia in CLBP.

Results

It was found that 43% of patients reported mild to severe insomnia after the development of back pain. In addition, 20% of patients met the criteria for clinically significant insomnia (ISI score ≥ 15). In a stepwise multivariate analysis, high pain intensity, the presence of comorbid musculoskeletal pain and neuropathic pain components, and high level of depression were strongly associated with clinical insomnia in CLBP. Among these factors, the presence of comorbid musculoskeletal pain other than back pain was the strongest determinant, with the highest odds ratio of 8.074 (95% CI 4.250 to 15.339) for predicting clinical insomnia.

Conclusions

Insomnia should be addressed as an integral part of pain management in CLBP patients with these risk factors, especially in patients suffering from CLBP with comorbid musculoskeletal pain.

The association between lower back pain and health status, work productivity, and health care resource use in Japan

Introduction

This study investigated the effect of pain severity on health status, work productivity, health care resource use, and costs among respondents with lower back pain (LBP), in Japan.

Materials and methods

Data from the 2013 Japan National Health and Wellness Survey, a survey of Japanese adults, were analyzed (N=30,000). All respondents provided informed consent, and the protocol was institutional review board-approved. Respondents who reported experiencing LBP were propensity score–matched to those without LBP, based on demographics and health history. Using regression modeling, patients with mild, moderate, and severe pain were compared against matched controls, with respect to health status (Mental and Physical Component Summary scores, and health utilities from the Short Form^®-36 Health Survey version 2), work productivity (Work Productivity and Activity Impairment – General Health version), health care resource use, and annual per-patient costs (estimated using published annual wages and resource use event costs).

Results

A total 1,897 patients reported experiencing LBP in the past month (6.32%); 52.45% reported their pain as mild, 32.79% as moderate, and 14.76% as severe. Increasing pain severity was associated with significantly lower levels of mental component scores (46.99 [mild], 42.93 [moderate], and 40.58 [severe] vs 48.10 [matched controls]), physical component scores (50.29 [mild], 46.74 [moderate], and 43.94 [severe] vs 52.93 [matched controls]), and health utilities (0.72 [mild], 0.66 [moderate], and 0.62 [severe] vs 0.76 [matched controls]) (all P<0.05). Indirect costs were significantly higher (P<0.05) among those with moderate (¥1.69 million [MM] [equivalent to $17,000, based on United States dollar exchange rates on September 1, 2014]) and severe (¥1.88 MM [$19,000]) pain, relative to matched controls (¥0.95 MM [$9,500]). Direct costs were only marginally different (P=0.05) between those with severe pain and matched controls (¥1.33 MM [$13,000] vs ¥0.54 MM [$5,000]).

Conclusion

Increasing pain severity among respondents with LBP was associated with significantly worse health status, to a clinically-relevant degree, along with greater indirect and direct costs, in Japan.

The prevalence and characteristics of low back pain among sitting workers in a Japanese manufacturing company

BACKGROUND

Low back pain (LBP) is a major public health problem and the most common cause of workers' disability, resulting in substantial economic burden in terms of workers' compensation and medical costs. Sitting is a recognized potential risk factor for developing LBP. Therefore, eliminating risk factors associated with working conditions and individual work capacity may be beneficial in preventing LBP in sitting workers. The purpose of this prospective cross-sectional study is to investigate the prevalence of LBP and examine risk factors that contribute to the development of LBP in sitting workers at an electronics manufacturing company.

METHODS

A cross-sectional survey was administered to all subjects to assess the prevalence of LBP persisting for at least 48 h during the recent week. Data on demographic characteristics and potential risk factors for LBP were collected at routine annual check-ups. Patients with LBP completed the Roland-Morris Disability Questionnaire (RDQ), which provided information on the attributes of LBP. Univariate and multivariate regression analyses examined the association between LBP and potential risk factors.

RESULTS

Of the 1,329 sitting workers, 201 (15.1 %) acknowledged experiencing LBP during the recent week. In female workers, weight and body mass index were significantly correlated with the RDQ score. Univariate analyses identified male sex, prior history of LBP, height ≥170 cm, and weight ≥70 kg as significant risk factors of LBP. Multivariate logistic regression analyses identified prior history of LBP and past history of lumbar spine surgery as significant risk factors of LBP.

CONCLUSIONS

This study characterized the prevalence and attributes of LBP in Japanese sitting workers and provided information about potential risk factors contributing to occurrence of LBP in the workplace.

Poor sleep quality is strongly associated with subsequent pain intensity in patients with acute low back pain

OBJECTIVE

Recent research suggests that sleep quality and pain intensity are intimately linked. Although sleep problems are common in patients with low back pain, the effect of sleep quality on the levels of pain intensity is currently unknown. The aim of this study was to investigate the effect of sleep quality on subsequent pain intensity in patients with recent-onset low back pain.

METHODS

Data on 1,246 patients with acute low back pain were included in the analysis. Sleep quality was assessed using the sleep quality item of the Pittsburgh Sleep Quality Index, scored on a 0-3-point scale, where 0 = very good sleep quality and 3 = very bad sleep quality. Pain intensity was assessed on a numerical rating scale (range 0-10). A generalized estimating equation (GEE) analysis modeled with an exchangeable correlation structure was used to examine the relationship between sleep quality and pain intensity. The model further controlled for symptoms of depression and prognostic factors for low back pain.

RESULTS

The GEE analysis demonstrated a large effect of poor sleep on subsequent pain intensity, such that for every 1-point decrease in sleep quality (based on a 0-3-point scale), pain intensity (based on a 0-10-point scale) increased by 2.08 points (95% confidence interval 1.99-2.16). This effect was independent of depression and common prognostic factors for low back pain.

CONCLUSION

Sleep quality is strongly related to subsequent pain intensity in patients with acute low back pain. Future research is needed to determine whether targeting sleep improvement contributes to pain reduction.

Assessment of depression, anxiety, sleep disturbance, and quality of life in patients with chronic low back pain in Korea

Background

Chronic low back pain (CLBP) has a significant effect on quality of life and imposes a great economical burden on society. In a number of studies, validated questionnaires had been given to CLBP patients to determine their health-associated quality of life, sleep disturbance, and psychological status. However, such outcome studies had not been performed previously in Korea.

Methods

We used self-report questionnaires to compare CLBP patients with an age- and sex-matched healthy control group. Between September 2012 and August 2013, we enrolled 47 patients who had CLBP for more than 3 months (group P) and 44 healthy age- and sex-matched controls (group C), who completed the following self-report questionnaires: 36-Item Short Form Health Survey (SF-36), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Oswestry Disability Index (ODI), and Pittsburgh Sleep Quality Index (PSQI).

Results

The scores from the ODI, BDI, and BAI were significantly higher in group P than in group C. The SF-36 scores were significantly lower in group P than in group C, suggesting lower quality of life in group P. The incidence of depression and anxiety was significantly higher in group P than in group C. However, neither the PSQI score nor the incidence of sleep disturbance was significantly different between the groups.

Conclusions

Patients with CLBP showed considerable functional disability and significant impairment of psychological status with a low quality of life. Hence, it is important to evaluate CLBP patients to provide adequate psychological support.

Assessing sleep disturbance in low back pain: the validity of portable instruments

Although portable instruments have been used in the assessment of sleep disturbance for patients with low back pain (LBP), the accuracy of the instruments in detecting sleep/wake episodes for this population is unknown. This study investigated the criterion validity of two portable instruments (Armband and Actiwatch) for assessing sleep disturbance in patients with LBP. 50 patients with LBP performed simultaneous overnight sleep recordings in a university sleep laboratory. All 50 participants were assessed by Polysomnography (PSG) and the Armband and a subgroup of 33 participants wore an Actiwatch. Criterion validity was determined by calculating epoch-by-epoch agreement, sensitivity, specificity and prevalence and bias- adjusted kappa (PABAK) for sleep versus wake between each instrument and PSG. The relationship between PSG and the two instruments was assessed using intraclass correlation coefficients (ICC 2, 1). The study participants showed symptoms of sub-threshold insomnia (mean ISI = 13.2, 95% CI = 6.36) and poor sleep quality (mean PSQI = 9.20, 95% CI = 4.27). Observed agreement with PSG was 85% and 88% for the Armband and Actiwatch. Sensitivity was 0.90 for both instruments and specificity was 0.54 and 0.67 and PABAK of 0.69 and 0.77 for the Armband and Actiwatch respectively. The ICC (95%CI) was 0.76 (0.61 to 0.86) and 0.80 (0.46 to 0.92) for total sleep time, 0.52 (0.29 to 0.70) and 0.55 (0.14 to 0.77) for sleep efficiency, 0.64 (0.45 to 0.78) and 0.52 (0.23 to 0.73) for wake after sleep onset and 0.13 (-0.15 to 0.39) and 0.33 (-0.05 to 0.63) for sleep onset latency, for the Armband and Actiwatch, respectively. The findings showed that both instruments have varied criterion validity across the sleep parameters from excellent validity for measures of total sleep time, good validity for measures of sleep efficiency and wake after onset to poor validity for sleep onset latency.

Association between housing quality and individual health characteristics on sleep quality among Latino farmworkers

Although poor sleep quality and associated sleep disorders are associated with increased risk of job injury and multiple mental and physical health problems, scant research has examined sleep quality among Latino farmworkers. Interviews were conducted with 371 male Latino farmworkers working in North Carolina during the 2010 agricultural season. Data on housing quality and sleep quality were collected. Access to air conditioning was significantly and positively associated with good sleep quality. This association remained when other housing characteristics and individual health indicators were controlled. Good sleep quality was associated with low levels of pain, depression, and anxiety. Poor sleep quality among Latino farmworkers was associated with poorer indicators of health. One important indicator of housing quality, air conditioning, was associated with better sleep quality. Further research is required to delineate how to improve the adequacy of farmworker housing to improve sleep quality and other health indicators.

Assessing the association between the degree of pain and socioeconomic status among older persons in Ghana

Objectives:

The current study sought to examine the association between the degree of pain and socioeconomic status among older male and female Ghanaians.

Method:

Data were drawn from the 2007–08 World Health Organization Global Ageing and Adult Health (SAGE) survey conducted in Ghana (Young adults=803, Adults=1689 and Older adults=2616). This includes bodily aches Ghanaians experienced in the last 30 days. Analyses of the association of pain with predisposing and enabling factors were carried out by means of ordinal logistic regression analysis.

Results:

In the age-adjusted model, pain was statistically significantly associated with the cohabitating group as its marginal effect suggests that respondents in that category were less likely to experience pain as related to the others in women.

Conclusion:

This study established that Ghanaian men go through more pain than their women counterparts. This article is premier to our knowledge to apply ordered logistic for the degree of pain.

Cognitive interviews guide design of a new CAM patient expectations questionnaire

Background

No consistent relationship exists between pre-treatment expectations and therapeutic benefit from various complementary and alternative medicine (CAM) therapies in clinical trials. However, many different expectancy measures have been used in those studies, with no validated questionnaires clearly focused on CAM and pain. We undertook cognitive interviews as part of a process to develop and validate such a questionnaire.

Methods

We reviewed questions about expectations of benefits of acupuncture, chiropractic, massage, or yoga for pain. Components of the questions – verbs, nouns, response options, terms and phrases describing back pain – were identified. Using seven different cognitive interview scripts, we conducted 39 interviews to evaluate how individuals with chronic low back pain understood these individual components in the context of expectancy questions for a therapy they had not yet received. Chosen items were those with the greatest agreement and least confusion among participants, and were closest to the meanings intended by the investigators.

Results

The questionnaire drafted for psychometric evaluation had 18 items covering various domains of expectancy. “Back pain” was the most consistently interpreted descriptor for this condition. The most understandable response options were 0-10 scales, a structure used throughout the questionnaire, with 0 always indicating no change, and 10 anchored with an absolute descriptor such as “complete relief”. The use of words to describe midpoints was found to be confusing. The word “expect” held different and shifting meanings for participants. Thus paired items comparing “hope” and “realistically expect” were chosen to evaluate 5 different aspects of treatment expectations (back pain; back dysfunction and global effects; impact of back pain on specific areas of life; sleep, mood, and energy; coping). “Impact of back pain” on various areas of life was found to be a consistently meaningful concept, and more global than “interference”.

Conclusions

Cognitive interviews identified wordings with considerable agreement among both participants and investigators. Some items widely used in clinical studies had different meanings to participants than investigators, or were confusing to participants. The final 18-item questionnaire is undergoing psychometric evaluation with goals of streamlining as well as identifying best items for use when questionnaire length is constrained.

Major depressive disorder and sleep disturbance in patients with chronic pain

BACKGROUND

Disturbed sleep is a common problem in both chronic pain and major depressive disorder (MDD). Moreover, many patients with chronic pain are depressed.

OBJECTIVES

To examine the effects of depression on the sleep behaviour of chronic pain patients by comparing patients who did or did not meet diagnostic criteria for MDD.

METHODS

A total of 60 patients with chronic musculoskeletal pain underwent structured diagnostic interviews for MDD and insomnia, and completed questionnaires assessing pain severity, disability, sleep quality, beliefs and attitudes about sleep, and sleep hygiene. For four consecutive days, they also completed a sleep diary, and reported on sleep hygiene practices and presleep arousal.

RESULTS

Thirty-three patients (55%) met diagnostic criteria for MDD, most of whom (n=32 [97%]) also fulfilled criteria for insomnia disorder. Insomnia was also common among patients without MDD (21 of 27 [78%]). Participants with MDD had higher self-reports of pain, disability, dysfunctional beliefs about sleep, and, on a prospective basis, greater presleep arousal and poorer sleep hygiene. However, diary assessments of specific sleep parameters (eg, sleep onset latency, total sleep time, sleep efficiency) did not differ between the groups.

DISCUSSION

Chronic pain patients with comorbid MDD exhibited more dysfunctional beliefs about sleep, poorer sleep hygiene practices and greater presleep arousal; however, diary-recorded sleep characteristics may not differ from those of patients without MDD. Chronic pain itself may disturb sleep so extensively that MDD introduces little additive effect.

CONCLUSION

MDD in chronic pain may be related to the cognitive and behavioural aspects of insomnia, rather than to an incremental disturbance in the initiation or maintenance of sleep.

Comorbid insomnia in patients with chronic pain: a study based on the Swedish quality registry for pain rehabilitation (SQRP)

PURPOSE

This study investigates the prevalence of insomnia and its relationship to other symptoms and health aspects in patients with chronic pain.

METHODS

Patients with chronic pain conditions (n = 845) referred to a multidisciplinary pain centre completed surveys provided by the Swedish quality registry for pain rehabilitation (SQRP). The SQRP collects data on socio-demographics, health status, symptoms of pain, mood and insomnia and life satisfaction.

RESULTS

The majority of patients (65.3%) had clinical insomnia according to the insomnia severity index (ISI). Insomnia correlated significantly but weakly with pain, depression, anxiety and coping; the strongest multivariate correlations were found with depression and anxiety followed by pain interference and pain severity. Pain intensity, depression and anxiety correlated stronger than ISI with respect to the two investigated aspects of health.

CONCLUSIONS

The prevalence of insomnia is high in patients with chronic pain conditions, but the level of importance in relation to other symptoms for health aspects is low, and the associations with other important symptoms are relatively weak. One way to increase the effects of multimodal rehabilitation programs may be to provide interventions directed specifically at insomnia rather than focusing only on interventions that address pain, depression and anxiety. Implications for Rehabilitation The prevalence of insomnia is high in patients with complex chronic pain conditions. Relatively low correlations existed between insomnia and pain intensity, depression, anxiety and other psychological aspects. Pain intensity, anxiety and depression were more important for perceived health aspects than insomnia. One way to increase the effects of multimodal rehabilitation programs may be to also include interventions directed directly to insomnia.

Sleep enhances learning of a functional motor task in young adults

BACKGROUND

Sleep has been demonstrated to enhance simple motor skill learning "offline" in young adults. "Offline learning" refers to either the stabilization or the enhancement of a memory through the passage of time without additional practice. It remains unclear whether a functional motor task will benefit from sleep to produce offline motor skill enhancement. Physical therapists often teach clients functional motor skills; therefore, it is important to understand how sleep affects learning of these skills.

OBJECTIVE

The purpose of this study was to determine whether sleep enhances the learning of a functional motor task.

DESIGN

A prospective, cross-sectional, repeated-measures design was used.

METHODS

Young participants who were healthy (N=24) were randomly assigned to either a sleep group or a no-sleep group. The sleep group practiced a novel walking task in the evening and underwent retention testing the following morning, and the no-sleep group practiced the task in the morning and underwent retention testing in the evening. Outcome measures included time around the walking path and spatiotemporal gait parameters.

RESULTS

Only participants who slept after practicing the novel walking task demonstrated a significant offline improvement in performance. Compared with the no-sleep group, participants in the sleep group demonstrated a significant decrease in the time around the walking path, an increase in tandem velocity, an increase in tandem step length, and a decline in tandem step time.

LIMITATIONS

Time-of-day effect and inability to ensure a certain amount of sleep quantity and quality of participants were limitations of the study.

CONCLUSIONS

This study is the first to provide evidence that sleep facilitates learning clinically relevant functional motor tasks. Sleep is an important factor that physical therapists should consider when teaching clients motor skills.