Two-way relationship between lack of sleep and back pain found

New research from the University of Sydney shows that treatment for insomnia can help to reduce back pain, “further enforcing the complex link between sleep and pain”, the researchers say.

Chronic low back pain is the leading cause of disability worldwide, affecting an estimated 540 million people at any one time, the researchers noted, with more than 59 percent of those sufferers also experiencing insomnia.

The new study, published in Osteoarthritis and Cartilage, analysed data from 24 randomised controlled clinical trials treating sleep disorders in more than 1550 people with osteoarthritis and back or neck pain. Results showed that for people with back pain, sleep interventions like cognitive behavioural therapy and medication improved sleep by 33 percent and improved pain by 14 percent compared to control or placebo.

According to Dr Milena Simic, who is a research physiotherapist in the University’s faculty of health sciences, the evidence suggested that there is a “two-way relationship between sleep and pain, meaning poorer sleep may lead to worse pain, and worse pain may lead to poorer sleep”.

“These findings highlight that we can improve sleep in people with painful conditions, and in some cases lead directly to less pain,” said Dr Simic.

“With limited effective treatment available for back pain it made sense for us to look at the impact treating insomnia could have on back pain sufferers who also often report poor quality sleep, early waking and difficulty initiating and maintaining sleep.”

The findings also gave rise to suggestions that a minimum of 30 percent improvement in sleep is required to see subsequent improvements in pain and this threshold was not met in the osteoarthritis group, argued the study’s lead author and PhD candidate Kevin Ho.

Based on the study results, the researchers said health professionals treating patients for back pain should also be conscious of screening for insomnia and referring for management.

“These findings highlight the importance of not treating painful musculoskeletal conditions in isolation,” said associate professor Paulo Ferreira.

“Depression and insomnia are both risk factors for developing low back pain, and people with depression often have poor sleep.”

“A person might see their GP or physiotherapist for back pain, but if they are not mentioning other issues such as sleep problems, anxiety or depression, we miss the potential to treat these co-existing conditions. This research suggests we may see even bigger improvement if we were to treat insomnia and back pain simultaneously,” she concluded.