PainRelief.com Interview with:
Eric J. Roseen, DC, MSc
Assistant Professsor, Department of Family Medicine
Boston University School of Medicine and Boston Medical Center
PainRelief.com: What is the background for this study? What are the main findings?
Response: Sleep disturbance and insomnia are common among people with chronic low back pain (cLBP). Previous research showed that 59% of people with cLBP experience poor sleep quality and 53% are diagnosed with insomnia disorder. Medication for both sleep and back pain can have serious side effects, and risk of opioid-related overdose and death increases with use of sleep medications. Given the serious risks of combining pain and sleep medications, we evaluated the use of nonpharmacologic approaches to manage sleep quality in adults with chronic low back pain.
Our randomized controlled trial included 320 adults with chronic low back pain from predominantly low-income racially diverse neighborhoods of Boston. At the beginning of the study, over 90 percent of participants with cLBP reported poor sleep quality. Participants were randomly assigned one of three different therapies for cLBP: physical therapy (PT), weekly yoga, or reading educational materials. Our previous research showed that yoga and PT are similarly effective for lowering pain and improving physical function, and reduced the need for pain medication. In this study, results for sleep improvements were compared over a 12-week intervention period and after 1 year of follow-up.
PainRelief.com: What are the main findings?
Response: We observed improvements in sleep quality lasting 52 weeks after 12 weeks of yoga classes or 1-on-1 PT, which suggests a potential long-term benefit. In addition, participants with early improvements in pain after 6 weeks of treatment were three and a half times more likely to have improvements in sleep after the full, 12-week treatment, highlighting that pain and sleep are closely related.
PainRelief.com: What should readers take away from your report?
Response: We observed improvements in sleep quality lasting 52 weeks after 12 weeks of yoga classes or 1-on-1 PT, which suggests a potential long-term benefit. In addition, participants with early improvements in pain after 6 weeks of treatment were three and a half times more likely to have improvements in sleep after the full, 12-week treatment, highlighting that pain and sleep are closely related.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response:
- Future studies of chronic low back pain should include sleep as an outcome.
- Frequent prospective measurements of pain and sleep (e.g., weekly) may allow researchers to understand potential causal relationships between clinical interventions and pain/sleep outcomes, i.e. do pain improvements mediate sleep improvements or vice versa?
- We measured sleep with the Pittsburgh Sleep Quality Index, a reliable/validated measure. Studies focused on both pain and sleep may want to also use objective measures of sleep quality (e.g., polysomnography)
- Future studies may be able tailor yoga or physical therapy interventions to maximize effectiveness for patients with co-occurring back pain and sleep problems. This could include timing of intervention (e.g., bedtime yoga) or adding concepts from other effective nonpharmacologic sleep interventions to either approach, such as sleep hygiene or Cognitive Behavioral Therapy for Insomnia.
Any disclosures?
This study was based at Boston Medical Center/Boston University School of Medicine. It was funded by the National Center for Complementary and Integrative Health (NCCIH), under grant numbers 1F32AT0092 (Roseen) and 5R01-AT005956 (Saper). Our colleagues at Harvard Medical School (Bertisch, Redline) are currently evaluating yoga for sleep quality in a separate study (NCCIH, R34 AT008923).
Citation:
Roseen, E.J., Gerlovin, H., Femia, A. et al. J GEN INTERN MED (2019). https://doi.org/10.1007/s11606-019-05329-4
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Last Updated on November 21, 2019 by PainRelief.com