02765nas a2200397   4500000000100000008004100001653001000042653001100052653001100063653002200074653000900096653002200105653001600127653001400143653003000157653001800187653002100205653002500226653004200251653001800293653002400311653002900335653002500364100001800389700002200407700001500429700001700444700001800461700001500479700002500494245011500519300001200634490000700646520170000653022001402353       2014                            d10aAdult10aFemale10aHumans10aFollow-Up Studies10aMale10aTreatment Outcome10aMiddle Aged10aPrognosis10aSeverity of Illness Index10aLow back pain10aPain Measurement10aLongitudinal Studies10aRandomized Controlled Trials as Topic10aAcetaminophen10aModels, Statistical10aAnalgesics, Non-Narcotic10aSleep Wake Disorders1 aLin Chung-Wei1 aMaher Christopher1 aLo Serigne1 aAlsaadi Saad1 aMcAuley James1 aHush Julia1 aWilliams Christopher00aPoor sleep quality is strongly associated with subsequent pain intensity in patients with acute low back pain.  a1388-940 v663 a<p>
<b>OBJECTIVE: </b>Recent research suggests that sleep quality and pain intensity are intimately linked. Although sleep problems are common in patients with low back pain, the effect of sleep quality on the levels of pain intensity is currently unknown. The aim of this study was to investigate the effect of sleep quality on subsequent pain intensity in patients with recent-onset low back pain.
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<b>METHODS: </b>Data on 1,246 patients with acute low back pain were included in the analysis. Sleep quality was assessed using the sleep quality item of the Pittsburgh Sleep Quality Index, scored on a 0-3-point scale, where 0 = very good sleep quality and 3 = very bad sleep quality. Pain intensity was assessed on a numerical rating scale (range 0-10). A generalized estimating equation (GEE) analysis modeled with an exchangeable correlation structure was used to examine the relationship between sleep quality and pain intensity. The model further controlled for symptoms of depression and prognostic factors for low back pain.
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<b>RESULTS: </b>The GEE analysis demonstrated a large effect of poor sleep on subsequent pain intensity, such that for every 1-point decrease in sleep quality (based on a 0-3-point scale), pain intensity (based on a 0-10-point scale) increased by 2.08 points (95% confidence interval 1.99-2.16). This effect was independent of depression and common prognostic factors for low back pain.
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<b>CONCLUSION: </b>Sleep quality is strongly related to subsequent pain intensity in patients with acute low back pain. Future research is needed to determine whether targeting sleep improvement contributes to pain reduction.
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