October 16, 2019
Sleep disturbance may be associated with reduced improvements in pain interference and pain severity in patients with chronic pain, regardless of whether they are treated with opioids, according to results published in Pain Medicine.
The study included 240 participants with chronic back pain or hip/knee osteoarthritis (OA) pain who were randomly assigned to receive opioid therapy or nonopioid medication therapy (n=120 in each group). The researchers used mixed models for repeated measures to determine the effect of baseline sleep disturbance scores on pain outcomes in the presence vs absence of an opioid therapy, and whether such disturbances could predict improvements in pain outcomes.
Of the 238 participants who completed the study, 80 (34%) reported severe sleep disturbance at baseline.
Testing for interaction of baseline sleep disturbance score by opioid treatment group did not yield any differences for Brief Pain Inventory (BPI) interference or severity, indicating that the level of baseline sleep disturbance may not have an effect on the impact of the presence vs absence of opioid therapy on pain outcomes.
Baseline sleep disturbance scores were found to predict reduced improvement in BPI interference (P =.0002). Every 10 points higher of baseline Patient-Reported Outcomes Measurement Information System sleep disturbance score were found to correlate with a 0.58-point reduction in BPI interference. Baseline sleep disturbance was also found to predict less improvement in BPI severity (P=.0164).
Study limitations include the fact that it was not a prespecified analysis, that participants were Veterans Affairs patients who were primarily male, that sleep was not assessed at all time points, and that the study was not designed to investigate the sleep-pain relationship.
“Evidence-based behavioral sleep treatments should be considered to optimize outcomes for patients with chronic pain,” noted the researchers.
Koffel E, Kats AM, Kroenke K, et al. Sleep disturbance predicts less improvement in pain outcomes: secondary analysis of the SPACE randomized clinical trial [published online September 14, 2019]. Pain Med. doi:10.1093/pm/pnz221
Tags: Non-Opioid, Chronic Pain, sleep-disturbance, Pain Medicine