The Association Between Chronic Low Back Pain and Sleep: a Systematic Review

Objectives: chronic low back pain (CLBP) adversely affects many quality of life components, and is reported to impair sleep. The aim of this review was to determine the association between CLBP and sleep.

Methods: this review comprised 3 phases: an electronic database search (PubMed, Cinahl Plus, EMBASE, PsychInfo, Pedro, and Cochrane Library) identified potential articles; these were screened for inclusion criteria by 2 independent reviewers; extraction of data from accepted articles; and rating of internal validity by 2 independent reviewers and strength of the evidence using valid and reliable scales.

Results: the search generated 17 articles that fulfilled the inclusion criteria (quantitative n=14 and qualitative n=3). CLBP was found to relate to several dimensions of sleep including: sleep disturbance and duration (n=15), sleep affecting day-time function (n=5), sleep quality (n=4), sleep satisfaction and distress (n=4), sleep efficiency (n=4), ability to fall asleep (n=3), and activity during sleep (n=3). Consistent evidence found that CLBP was associated with greater sleep disturbance; reduced sleep duration and sleep quality; increased time taken to fall asleep; poor day-time function; and greater sleep dissatisfaction and distress. Inconsistent evidence was found that sleep efficiency and activity were adversely associated with CLBP.

Discussion: many dimensions of sleep are adversely associated with CLBP. Management strategies for CLBP need to address these to maximize quality of life in this patient cohort.