Opioids Linked to Sleep Disturbances in Patients With Chronic Low Back Pain

Interventions targeting sleep quality may help to improve pain management and functional ability among patients with chronic low back pain (cLBP) taking opioid medications, according to authors of a study published in Pain Medicine. Opioid use, they found, moderated the relationship between sleep disturbances and both physical functioning and pain interference.

Patients with cLBP report sleep disturbances, which can worsen pain and impair physical functioning. Although opioid medications are often prescribed to patients with cLBP to provide short-term relief, some research suggests that they disrupt sleep patterns. Little is known about how sleep disturbance and opioid use interact to impact pain and functioning.

Therefore, the authors sought to investigate whether opioids moderated the associations of sleep disturbance with physical functioning or pain outcomes in cLBP by recruiting patients through the Partners Healthcare Clinical Trials website, email, bulletin boards, the Internet, and electronic medical record databases from Brigham and Women’s Hospital and Massachusetts General Hospital from 2013 to 2020. Eligibility criteria were self-reported cLBP of at least 3 months’ duration, an average pain rating of 4 or higher, and no comorbid medical or pain conditions. A total of 213 patients (58% female; average age 42.8 years [range, 18-65 years]) were included in the study. The majority (90%) of patients were non-Hispanic (75% White, 12% African American/Black; 4% Asian).

Patient-Reported Outcomes Measurement Information System (PROMIS) short forms were used use assess pain severity, pain interference, physical functioning, and sleep disturbance. In addition, participants completed PROMIS measures of depression, anxiety, and fatigue and reported (yes, no) whether they used opioid medications for their back pain.

Approximately one-quarter of patients (24%) reported using opioid medications to manage their cLBP. Opioid use moderated the relationship between sleep disturbances and physical functioning (b=–0.22; 95% CI, –0.39 to –0.05, P =.011), as well as pain interference (b=0.23; 95% CI, 0.02-0.44; P =.031). Patients who used opioid medications and experienced sleep disturbances had worse physical functioning (b= –0.36; 95% CI, –0.51 to –0.20; P <.001) and greater pain interference (b =0.35; 95% CI, 0.16-0.54, P <.001), compared with patients who had cLBP but did not use opioids. However, there was no significant effect of opioid status on the correlation between sleep disturbance and pain severity.

Study limitations include the use of cross-sectional rather than prospective, longitudinal study data; and the fact that the authors did not comprehensively assess patients’ opioid use, sleep disturbance, or medical history. Additionally, the fact that most of the patients were non-Hispanic White may limit the generalizability of the findings.

“These findings have important clinical implications, suggesting that interventions targeting sleep quality could be especially beneficial for pain management and functional ability among patients with cLBP taking opioid medications,” the authors concluded.