Treating insomnia improves back pain

A new analysis from the University of Sydney shows treatment for insomnia can help to reduce back pain, further enforcing the complex link between sleep and pain.

Chronic low back pain is the leading cause of disability worldwide, affecting an estimated 540 million people at any one time. More than 59 percent of sufferers also experience insomnia.

The 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 in 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.

“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.”

Under Guidelines from the American College of Physicians the first step in treating insomnia is cognitive behavioural therapy, a type of psychotherapy based on challenging unhelpful thoughts and behaviours. If this is unsuccessful it can be combined with short term use of insomnia medication.

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

“These findings highlight the importance of not treating painful musculoskeletal conditions in isolation,” said study co-author Associate Professor Paulo Ferreira of the Faculty of Health Sciences and Charles Perkins Centre who led a 2016 study showing a link between depression and back pain.

“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.”

Interestingly, while low back pain improved with insomnia treatments, participants with knee osteoarthritis did not appear to experience major reductions in pain despite minor improvements in sleep.

Lead author and PhD Candidate Kevin Ho said that the findings tend to suggest 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.

The researchers’ next step is to carry out studies on combined treatments. They are also exploring the effectiveness of a fully online cognitive behaviour therapy sleep treatment for people with low back pain and insomnia symptoms.