Goal of the Study?
In this systematic review from the Journal of Clinical Medicine 1 the authors’ goal was to investigate the assumed association between sleep and Chronic Spinal Pain by providing an overview and update of relevant literature from the last decade 2009 to 2019.
Why are they doing this study?
Chronic Spinal Pain (CSP), including both neck and back pain, is a common disabling disorder in which sleep problems are frequently reported as a comorbidity. The complex processes of both sleep and CSP seem to have overlapping mechanisms, which may explain their bidirectional relationship. Addressing frequently reported sleep problems in Chronic Lower Back Pain (CLBP) patients appears to be a necessary complement to pain management.
What was done?
Eligible studies starting in January 2009 were obtained by searching four major electronic databases; PubMed, Embase, Web of Science and PsycATICLES for a series of keywords. This yielded 3,764 articles. After removing duplicates the remaining 2,802 studies were screened by title, abstract and availability of full text. This resulted in only 27 eligible articles. These 27 articles were grouped into 3 different types of observational study design;
- cohort-based (6) studies, which are used to study incidence, causes, and prognosis. Because they measure events in chronological order they can be used to distinguish between cause and effect.
- case-control (5) studies that compare groups retrospectively and seek to identify possible predictors of outcome. These are normally used to generate hypotheses that can then be studied via prospective cohorts.
- cross-sectional (16) studies, which are used to determine prevalence. They are relatively quick and easy but do not permit distinction between cause and effect.
These articles were examined and scored for risk of bias and level of evidence by the authors. They looked for and scored possible verification bias; where the initial diagnostic test influences the selection of subjects and incorporation bias; where the diagnostic test is used in the follow-up analysis. Overall the methodological quality, bias and evidence of the 27 studies examined in detail was low to moderate.
What did they find?
The majority of the 27 articles fully examined indicated higher pain intensity levels were correlated with poorer sleep quality, more severe insomnia symptoms, more severe sleep disturbances, shorter sleep duration, worse actigraphy-derived sleep parameters (method for inferring sleep/wake patterns based on movement data gathered using actigraphs) and higher sleepiness.
Why do these findings matter?
Poor sleep results in an increasing hypersensitivity with variations in pain sensitivity occurring throughout the day. Because of this, disrupted sleep may reduce the effectiveness of pain management and delay recovery. In future research, electronic sleep and pain diaries would make it possible to collect additional data regarding the variable of pain management throughout the day, which may facilitate the optimization of pharmacological treatments.
At Dynamic Disc Designs, our models help in the education of a good nights rest as it relates to hydraulic spinal recovery. Encouraging good sleep hygiene is an often overlooked factor in managing a person with chronic spinal pain.