Abstract
Objective
To investigate the bidirectional relationship by determining whether baseline sleep
quality predicts pain intensity and whether baseline pain intensity predicts sleep
quality in older individuals with chronic low back pain (LBP).
Design
A prospective longitudinal cohort study with a 6-month follow-up period.
Setting
Community.
Participants
Older adults with LBP aged 60 years or older (N=215).
Intervention
Not applicable.
Main Outcome Measures
Data collection occurred at baseline and at 6 months. Pain intensity and sleep quality
were measured in both time points of assessment using the numeric pain rating scale
(range, 0-10) and the Pittsburg Sleep Quality Index. At baseline, we also collected
information on demographic anthropometric variables, cognitive status, depression,
and comorbidities. Multivariable linear regression analyses adjusted for potential
covariates were performed.
Results
A total of 215 individuals with LBP were recruited. Poor sleep quality at baseline
predicted high pain intensity at 6 months (β coefficient, 0.18; 95% confidence interval
[CI], 0.07-0.30). High pain intensity at baseline predicted poor sleep quality 6 months
later (β coefficient, 0.14; 95% CI, 0.01-0.26).
Conclusion
Our findings give some support to the bidirectional relationship between pain and
sleep quality in older individuals with LBP. This bidirectional relationship may be
used as prognostic information by clinicians when managing patients with LBP.
Keywords
List of abbreviations:
BMI (body mass index), CI (confidence interval), LBP (low back pain), NRS (numeric rating scale), PSQI (Pittsburgh Sleep Quality Index), RMDQ (Roland Morris Disability Questionnaire)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
United States Census Bureau. An aging world: 2015. Available at https://www.census.gov/library/publications/2016/demo/P95-16-1.html. Accessed August 22, 2021.
United Nations. World population ageing 2015. Available at https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/May/un_2015_worldpopulationageing_report.pdf. Accessed August 22, 2021.
- Healthy life expectancy for 187 countries, 1990-2010: a systematic analysis for the Global Burden Disease Study 2010.Lancet. 2012; 380: 2144-2162
- Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017.Ann Transl Med. 2020; 8: 299
- Prevalence of low back pain in older Brazilians: a systematic review with meta-analysis.Rev Bras Reumatol Engl Ed. 2016; 56: 258-269
- Prevalence of sleep disturbance in patients with low back pain.Eur Spine J. 2011; 20: 737-743
- Sleep disturbances as predictors of hospitalization for back disorders-a 28-year follow-up of industrial employees.Spine (Phila Pa 1976). 2006; 31: 51-56
- Persistent and developing sleep problems: a prospective cohort study on the relationship to poor outcome in patients attending a pain clinic with chronic low back pain.Pain Pract. 2018; 18: 79-86
- Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey.J Psychosom Res. 2004; 56: 497-502
- Sleep in normal aging.Sleep Med Clin. 2018; 13: 1-11
- Musculoskeletal pain as a marker of health auality. Findings from the Epidemiological Sleep Study among the adult population of São Paulo City.PLoS One. 2015; 10e0142726
- Sleep disturbances and back pain: systematic review and meta-analysis.Neuropsychiatr. 2020; 34: 74-84
- The bidirectional relationship between pain intensity and sleep disturbance/quality in patients with low back pain.Clin J Pain. 2014; 30: 755-765
- Should physical therapists assess sleep quality in patients seeking care for low back pain?.Phys Ther. 2019; 99: 961-963
- Psychological interventions that target sleep reduce pain catastrophizing in knee osteoarthritis.Pain. 2017; 158: 2189-2195
- Poor sleep and risk of falls in community-dwelling older adults: a systematic review.J Appl Gerontol. 2018; 37: 1059-1084
- Sleep disturbance and pain: a tale of two common problems.Chest. 2018; 154: 1249-1259
- Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis.J Abnorm Psychol. 1992; 101: 514-520
- Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression.Arthritis Rheum. 2008; 59: 961-967
- The association between chronic low back pain and sleep: a systematic review.Clin J Pain. 2011; 27: 169-181
- Chapter 4. European guidelines for the management of chronic nonspecific low back pain.Eur Spine J. 2006; 15: S192-S300
- [The Mini-Mental State Examination in a general population: impact of education] [Portuguese].Arq Neuropsiquiatr. 1994; 52: 01-07
- Is alcohol intake associated with low back pain? A systematic review of observational studies.Man Ther. 2013; 18: 183-190
- Low back pain and lifestyle. Part I: smoking. Information from a population-based sample of 29,424 twins.Spine (Phila Pa 1976). 1998; 23 (discussion 14): 2207-2213
- The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults.J Youth Adolesc. 1991; 20: 149-166
- Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis.Clin J Pain. 1997; 13: 163-170
- Translation, adaptation and validation of the Roland-Morris questionnaire–Brazil Roland-Morris.Braz J Med Biol Res. 2001; 34: 203-210
- The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research.Arthritis Rheum. 2003; 49: 156-163
- Assessing global pain severity by self-report in clinical and health services research.Spine (Phila Pa 1976). 2000; 25: 3140-3151
- Minimal clinically important change for pain intensity, functional status, and general health status in patients with nonspecific low back pain.Spine (Phila Pa 1976). 2006; 31: 578-582
- Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing.Front Psychol. 2016; 7 (1466-66)
- Validation of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older black and white women.Sleep Med. 2012; 13: 36-42
- The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.Psychiatry Res. 1989; 28: 193-213
- Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index.Sleep Med. 2011; 12: 70-75
- Prognosis for patients with chronic low back pain: inception cohort study.BMJ. 2009; 339: b3829
- The number of subjects per variable required in linear regression analyses.J Clin Epidemiol. 2015; 68: 627-636
- Determination of minimum sample size requirement for multiple linear regression and analysis of covariance: considering to get close approximation of the estimates with the parameters in a population.Epidemiol Biostat Public Health. 2017; 14: e12117
- What is the prognosis of back pain?.Best Pract Res Clin Rheumatol. 2010; 24: 167-179
- Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.Stat Med. 1996; 15: 361-387
- Prevalence of low back pain in the elderly population: a systematic review.Clinics. 2019; 74: e789
- Sleep and human aging.Neuron. 2017; 94: 19-36
- High baseline fat mass, but not lean tissue mass, is associated with high intensity low back pain and disability in community-based adults.Arthritis Res Ther. 2019; 21 (165-65)
- Associations between sleep conditions and body composition states: results of the EPISONO study.J Cachexia Sarcopenia Muscle. 2019; 10: 962-973
- The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings.Spine. 2012; 37: E668-E677
- Impact of sleep quality and comorbidities on health-related quality of life in patients with obstructive sleep apnea.Eur Respir J. 2019; 54: PA889
- Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment.J Cell Mol Med. 2019; 23: 2324-2332
- Epidemiology of chronic back pain among adults and elderly from Southern Brazil: a cross-sectional study.Braz J Phys Ther. 2021; 25: 344-351
- Fear of movement is not associated with objective and subjective physical activity levels in chronic nonspecific low back pain.Arch Phys Med Rehabil. 2017; 98: 96-104
- Multicollinearity and misleading statistical results.Korean J Anesthesiol. 2019; 72: 558-569
- Confounding and collinearity in regression analysis: a cautionary tale and an alternative procedure, illustrated by studies of British voting behaviour.Qual Quant. 2018; 52: 1957-1976
- The association between sleep quality, low back pain and disability: a prospective study in routine practice.Eur J Pain. 2018; 22: 114-126
- The cost of dichotomising continuous variables.BMJ. 2006; 332: 1080
- The added value of cognitive behavioral therapy for insomnia to current best evidence physical therapy for chronic spinal pain: protocol of a randomized controlled clinical trial.Braz J Phys Ther. 2019; 23: 62-70
- Cognitive-behavioral treatment of insomnia secondary to chronic pain.J Consult Clin Psychol. 2000; 68: 407-416
- The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain.Sleep Med. 2010; 11: 302-309
- Intraindividual variability in daily sleep and pain ratings among chronic pain patients: bidirectional association and the role of negative mood.Clin J Pain. 2011; 27: 425-433
Article info
Publication history
Published online: December 27, 2021
Accepted:
November 26,
2021
Received in revised form:
November 12,
2021
Received:
March 24,
2021
Footnotes
Disclosures: PKM, CG, TMD, and GHDG are supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brazil (CAPES)–Finance Code 001. DGDC is supported by grant from São Paulo Research Foundation (FAPESP; grant no. 2017/20589-0). MLA, RZP, and ST are fellowship recipients from the National Council for Scientific and Technological Development–CNPq. CF is supported by a grant from FAPESP (grant no. 2018/18952-1). PKM holds a fellowship from the Associaçao Fundo de Incentivo à Pesquisa (AFIP).
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
