Do Patients with Chronic Spinal Pain and Comorbid Insomnia Have More Features of Central Sensitization? A Case-Control Study
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design and Settings
2.2. Participants
2.3. Outcomes Measures
2.3.1. Pain-Related Information
2.3.2. Sleep-Related Outcomes
2.3.3. Physical Activity and Functioning Outcome
2.3.4. Anxiety, Depressive Symptoms, and Fatigue
2.3.5. Pressure Pain Thresholds
2.4. Procedure
2.5. Statistical Analysis
3. Results
3.1. Comparison Outcomes between CS and Non-CS Group
Sleep Outcomes
3.2. Physical Activity and Functioning Outcome
3.3. Anxiety, Depressive Symptoms, and Fatigue Outcomes
3.4. Pressure Pain Thresholds
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Inclusion | Exclusion |
---|---|
Aged between 18 and 65 years | Severe underlying sleep pathology (identified through baseline data of polysomnography) |
Nonspecific spinal pain (≥3 months duration), and presence of pain ≥ 3 days/week. | Neuropathic pain and chronic widespread pain syndromes |
Seeking care because of neck pain or low back pain | Shift workers |
Native Dutch speaker | Being pregnant or became a parent in the preceding year |
Having insomnia: no presence of other intrinsic sleep disorders | Thoracic pain in absence of neck or low back pain |
Not starting new treatments or medication, and continuing their usual care six weeks prior to and during study participation (to obtain a steady state) | Spinal surgery history (i.e., surgery for spinal stenosis) |
Refraining from analgesics and other substances that modulate the nervous system (caffeine, alcohol, or nicotine) in the 48 h prior to the assessments | Body Mass Index > 30 kg/m2 |
Nonspecific failed back surgery > 3 years are permitted | Current depression diagnosed by a doctor |
Not undertaking exercise 3 days before the assessments | Not willing to refrain from analgesics in the 48 h prior to the assessments |
Characteristics | CS Group (n = 82) | Non-CS Group (n = 41) | 95% CI | p-Value |
---|---|---|---|---|
Age, years | 38.7 ± 10.2 | 43.6 ± 12 | 0.80, 9.02 | 0.02 |
Body Mass Index, kg/m2 | 23 ± 3.3 | 23.9 ± 2.74 | −0.32, 2.04 | 0.15 |
Pain duration, months | 87 ± 92.3 | 93.4 ± 104 | −30.7, 43.4 | 0.70 |
Sex, n (%) | ||||
Female | 64 (78) | 18 (44) | −0.51, −0.17 | <0.001 |
Pain location, n (%) | ||||
Cervical pain | 50 (61) | 21 (51.2) | −0.42, 1.58 | 0.19 |
Back pain | 32 (39) | 20 (48.8) | −0.06, 0.31 | 0.21 |
CSI score range, n (%) | ||||
0–29 | − | 10 (8) | ||
30–39 | − | 31 (25) | ||
40–49 | 45 (36) | − | ||
50–59 | 26 (21) | − | ||
60–100 | 11 (9) | − | ||
CSI total score | 49.5 ± 7.4 | 32 ± 6 | −19.9, −15.0 | <0.001 |
Outcomes | CS Group (n = 81) | Non-CS Group (n = 41) | 95% CI | p-Value |
Objective sleep, median (Q3–Q1) | ||||
Time in bed | 476.7 (95) | 471.7 (82.1) | −36.3, 18.5 | 0.60 |
Total sleep time | 433.5 (79.1) | 409.5 (87) | −42, 3.3 | 0.07 |
Sleep onset latency | 10.5 (12) | 9.5 (12) | −8.8, 4.7 | 0.70 |
Wake duration after sleep onset | 26.7 (25.5) | 37.7 (49.5) | −0.53, 25.7 | 0.08 |
Sleep efficiency | 91.4 (8.1) | 90.7 (8.3) | −5.2, 0.37 | 0.15 |
Self-reported sleep, mean ± SD | ||||
Outcomes | CS group (n = 82) | Non-CS group (n = 41) | 95% CI | p-Value |
PSQI | 10.1 ± 2.6 | 8.3 ± 2.3 | −2.7, −0.90 | <0.01 |
ISI | 16.2 ± 3.8 | 13 ± 3.8 | −0.73, −0.33 | <0.01 |
DBAS-16 | 3.17 ± 0.4 | 2.65 ± 0.6 | −0.61, −0.24 | <0.01 |
ESS | 8.5 ± 4.7 | 7.7 ± 4.5 | −2.5, 0.96 | 0.30 |
Outcomes | CS Group (n = 76) | Non-CS Group (n = 40) | 95% CI | p-Value |
---|---|---|---|---|
Actigraphy, mean ± SD | ||||
% in light | 39.3 ± 6.1 | 39 ± 5.4 | −2.5, 1.96 | 0.79 |
% in sedentary | 48.4 ± 7.2 | 50 ± 6.9 | −1.1, 4.27 | 0.20 |
% in moderate | 12.1 ± 4.1 | 10.9 ± 4 | −2.8, 0.31 | 0.10 |
Functioning, mean ± SD | ||||
PCS (SF-36) | 213.6 ± 63.8 | 268.3 ± 59.7 | 31.5, 78.4 | <0.01 |
MCS (SF-36) | 238.8 ± 74 | 287 ± 67.2 | 21, 75.4 | 0.01 |
Outcomes | CS Group (n = 82) | Non-CS Group (n = 41) | 95% CI | p-Value |
---|---|---|---|---|
HADS, mean ± SD | ||||
Anxiety | 9.6 ± 3.6 | 7 ± 2.7 | −3.7, −1.3 | <0.001 |
Depressive symptoms | 5.6 ± 3.2 | 4.2 ± 3.2 | −2.6, −0.18 | <0.001 |
BFS, mean ± SD | ||||
Physical | 3.8 ± 2.1 | 2.4 ± 1.8 | −2, −0.62 | 0.001 |
Mental | 3.6 ± 2.5 | 2.5 ± 2.3 | −2, −0.14 | 0.02 |
Outcomes | CS Group (n = 82) | Non-CS Group (n = 41) | 95% CI | p-Value |
---|---|---|---|---|
Symptomatic site, mean ± SD | ||||
Trapezius (KPa) | 3.8 ± 2.3 | 5 ± 2.4 | 0.06, 1.8 | 0.03 |
Lumbar (KPa) | 5.2 ± 2.1 | 7.1 ± 3.3 | 0.08, 2.8 | <0.001 |
Remote site, mean ± SD | ||||
Hand (KPa) | 3.8 ± 1.3 | 4.5 ± 1.8 | 0.08, 1.2 | 0.02 |
Calf (KPa) | 4.5 ± 1.5 | 5.5 ± 2.1 | 0.03, 1.7 | 0.03 |
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Araújo Almeida, L.; Bilterys, T.; Van Looveren, E.; Mairesse, O.; Cagnie, B.; Meeus, M.; Moens, M.; Goubert, D.; Munneke, W.; Danneels, L.; et al. Do Patients with Chronic Spinal Pain and Comorbid Insomnia Have More Features of Central Sensitization? A Case-Control Study. Healthcare 2023, 11, 3152. https://doi.org/10.3390/healthcare11243152
Araújo Almeida L, Bilterys T, Van Looveren E, Mairesse O, Cagnie B, Meeus M, Moens M, Goubert D, Munneke W, Danneels L, et al. Do Patients with Chronic Spinal Pain and Comorbid Insomnia Have More Features of Central Sensitization? A Case-Control Study. Healthcare. 2023; 11(24):3152. https://doi.org/10.3390/healthcare11243152
Chicago/Turabian StyleAraújo Almeida, Lucas, Thomas Bilterys, Eveline Van Looveren, Olivier Mairesse, Barbara Cagnie, Mira Meeus, Maarten Moens, Dorien Goubert, Wouter Munneke, Lieven Danneels, and et al. 2023. "Do Patients with Chronic Spinal Pain and Comorbid Insomnia Have More Features of Central Sensitization? A Case-Control Study" Healthcare 11, no. 24: 3152. https://doi.org/10.3390/healthcare11243152