Review of the effects of medications on sleep in adults with chronic low back pain

Alternatives to using medications' such as opioids and antidepressants' to manage chronic low back pain and improve sleep should be considered by clinicians' according to a study by CQUniversity Honours graduate' Emma Craige.

Emma's research paper' 'Effects of pharmacotherapy on sleep-related outcomes in adults with chronic low back pain: a systematic review and meta-analysis of randomised controlled trials'' was recently accepted by The Lancet for publication in eClinicalMedicine .

It's a significant achievement for Emma' who is also a CQU Summer Research Scholarship and Australian Psychology Society Prize recipient' and isn't due to start her PhD until 2023.

Her study' which was an extension of her Bachelor of Psychological Sciences (Honours) in 2021' involved searching six major databases and screening thousands of scientific records.

"My honours thesis examined the effect of non-medication treatment on sleep in adults with chronic low back pain. In this extended study' we examined the effects of medication-based treatment to ensure we provided a comprehensive review on the effects of current treatment (medication-based and non-medication-based) on sleep in this vulnerable population'" she said.

"Chronic low back pain impacts one in six Australians. When coupled with sleep problems' individuals with chronic low back pain tend to recover slower and have a lower probability of a full recovery compared to those without sleep problems. Therefore' managing sleep problems in patients with chronic low back pain should be a clinical priority to support recovery.

"Australian and many other clinical guidelines around the world include recommendations for the use of medications' such as those that help manage pain and depression' for the management of chronic low back pain. These medications can influence sleep outcomes' such as sleep quality' sleep durations' and sleep disturbances – which may in turn influence changes in pain. The use of sleep medications in chronic low back pain populations may also influence pain.

"Considering medications are often associated with negative side effects' such as nausea' fatigue' misuse' or overdose' it is important that clinicians understand implications medications have on both pain and sleep – factors which can influence low back pain recovery."

Ninety per cent of people will experience chronic low back pain in their life time so understanding this relationship is critical for treatment plans.

Emma said her study recommended that' given the effects of pharmacotherapy on improving sleep were small and unlikely clinically meaningful' clinicians could consider alternative treatments' for example' non-medication interventions' when managing sleep in adults with chronic low back pain.

She thanked her supervisors' CQUniversity's Dr Grace Vincent and Professor Sally Ferguson' as well as Deakin University's Dr Patrick Owen for their support and guidance on the project.

"I hope the outcomes of this review will inform clinicians' patients' and policy makers of the realistic effects on sleep (and associated effect on pain and back-related disability) we can expect from medications used to manage chronic low back pain."

Emma's paper was published in eClinicalMedicine on' part of The Lancet' on 17 November.