Sleep and pain: relationship and management

Abstract

Abstract Background Research has identified that sleep and pain have a bidirectional relationship. Understanding this relationship specifically between chronic low back pain (LBP) and sleep may lead to improved management of painful conditions such as chronic LBP and postoperative pain. As pain is typically more difficult to manage the longer it persists; an advantageous approach to management of chronic pain may be to intervene early to prevent the transition from an acute episode to a chronic problem. Targeting sleep during an acute episode of pain may provide an option to accelerate recovery and prevent chronicity. Methods This project included 3 studies. The first study used a cross-sectional design to investigate the bi-directional relationship between chronic LBP pain and sleep. Correlations were used to determine whether pain intensity during the day was associated with differences in sleep architecture and whether these differences were associated with pain intensity the following day. The second study used a systematic review with meta-analysis to investigate whether managing sleep in the acute postoperative period improved postoperative pain. The third study was a pilot randomised controlled trial that investigated the feasibility of managing sleep in participants with acute low back pain. Results This research found that: 1.For people with LBP, slow wave sleep (SWS) and sleep quality were significantly associated with next day pain intensity such that people with LBP who spent less time in SWS reported both higher pain intensity the following day and worse sleep quality for the same night. 2. Hypnotic drugs in combination with other analgesics significantly improve pain and sleep post-operatively, however the effects were modest. 3. The pilot study identified barriers to recruitment necessary to address in a large trial in order to ensure completion in a practical timeframe, in a sample of Australian primary care practitioners. Those enrolled found the questionnaires suitable and the follow-up rates were good. Conclusions This research is a useful platform to better understand the complex relationship between pain and sleep. It provides a guide for future research in the area. Enhancing sleep quality continues to be a potentially undervalued resource in improving LBP and postoperative pain.