Good sleep optimizes pain outcomes in patients taking analgesics

Sleep disturbance appears to limit improvements in pain-related function and pain severity overall, regardless of analgesic regimen, according to a secondary analysis of the SPACE* trial.

The current analysis included 238 participants with chronic back pain or hip or knee osteoarthritis pain who received treatment with either opioid (n=120) or nonopioid medication therapy (n=120). In the entire cohort, 80 participants (34 percent) reported severe sleep disturbance.

Patients with vs without severe sleep disturbance had poorer baseline pain-related function (Brief Pain Inventory [BPI] interference score, 6.5 vs 5.0; p<0.0001) and pain severity (BPI severity score, 5.9 vs 5.2; p<0.0002). They also had higher depression (9.4 vs 4.4; p<0.0001), anxiety (5.8 vs 2.7; p<0.0001) and fatigue scores.

Worse sleep disturbance did not modify the relative effects of opioid vs nonopioid treatment on pain outcomes, but was significantly associated with reduced improvement in BPI interference (β, 0.058; p=0.0002) and BPI severity (β, 0.026; p=0.0164).

Specifically, each 10-point increase in baseline sleep disturbance score predicted 0.58- and 0.26-points less improvement in BPI interference and severity, respectively.

In light of the findings, improving sleep before or during pain treatment may be essential if outcomes for patients with chronic pain are to be optimized, researchers said. Clinicians should proactively assess and treat sleep disturbance in patients with chronic pain using evidence-based behavioural sleep interventions.

*Strategies for Prescribing Analgesics Comparative Effectiveness