Dr. Maher is recipient of an Australian Research Council Fellowship.
Poor Sleep Quality Is Strongly Associated With Subsequent Pain Intensity in Patients With Acute Low Back Pain†
Version of Record online: 28 APR 2014
Copyright © 2014 by the American College of Rheumatology
Arthritis & Rheumatology
Volume 66, Issue 5, pages 1388–1394, May 2014
How to Cite
Alsaadi, S. M., McAuley, J. H., Hush, J. M., Lo, S., Lin, C.-W. C., Williams, C. M. and Maher, C. G. (2014), Poor Sleep Quality Is Strongly Associated With Subsequent Pain Intensity in Patients With Acute Low Back Pain. Arthritis & Rheumatology, 66: 1388–1394. doi: 10.1002/art.38329
The study reported herein used data from a consecutive subset of participants from the PACE study, an investigator-initiated study funded by the National Health and Medical Research Council, Australia, with supplementary industry funding. The current study did not receive any funding.
- Issue online: 28 APR 2014
- Version of Record online: 28 APR 2014
- Accepted manuscript online: 27 JAN 2014 01:57PM EST
- Manuscript Accepted: 17 DEC 2013
- Manuscript Received: 5 FEB 2013
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.
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.
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.
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.