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

Kelly, Gráinne A. MSc, BSc*; Blake, Catherine PhD, MSc, BSc*; Power, Camillus K. MD; O'Keeffe, Declan MD; Fullen, Brona M. PhD, BSc*

doi: 10.1097/AJP.0b013e3181f3bdd5
Review Article

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.

*UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Belfield, Dublin 4

Department of Anaesthesia and Pain Medicine, Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin 24

Department of Anaesthesia and Pain Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland

Funded without conflict of interest by an unrestricted educational grant from Pfizer Healthcare Ireland, Dublin 24, Ireland.

Reprints: Gráinne Kelly, MSc, BSc, UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland (e-mail: Grainne.Kelly.1@ucdconnect.ie).

Received March 29, 2010

Accepted July 19, 2010

© 2011 Lippincott Williams & Wilkins, Inc.