Erin Koffel1,2, Allyson M Kats3, Kurt Kroenke4,5, Matthew J Bair4,5,6, Amy Gravely1, Beth DeRonne1, Melvin T Donaldson7, Elizabeth S Goldsmith1, Siamak Noorbaloochi1, Erin E Krebs1,7. 1. Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota. 2. Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota. 3. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota. 4. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. 5. Regenstrief Institute, Indianapolis, Indiana. 6. Center for Health Information and Communication, Roudebush Veterans Affairs Medical, Center, Indianapolis, Indiana. 7. University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Abstract
OBJECTIVE: Sleep disturbance may limit improvement in pain outcomes if not directly addressed in treatment. Moreover, sleep problems may be exacerbated by opioid therapy. This study examined the effects of baseline sleep disturbance on improvement in pain outcomes using data from the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial, a pragmatic 12-month randomized trial of opioid vs nonopioid medication therapy. DESIGN: Participants with chronic back pain or hip or knee osteoarthritis pain were randomized to either opioid therapy (N = 120) or nonopioid medication therapy (N = 120). METHODS: We used mixed models for repeated measures to 1) test whether baseline sleep disturbance scores modified the effect of opioid vs nonopioid treatment on pain outcomes and 2) test baseline sleep disturbance scores as a predictor of less improvement in pain outcomes across both treatment groups. RESULTS: The tests for interaction of sleep disturbance by treatment group were not significant. Higher sleep disturbance scores at baseline predicted less improvement in Brief Pain Inventory (BPI) interference (β = 0.058, P = 0.0002) and BPI severity (β = 0.026, P = 0.0164). CONCLUSIONS: Baseline sleep disturbance adversely affects pain response to treatment regardless of analgesic regimen. Recognition and treatment of sleep impairments that frequently co-occur with pain may optimize outcomes. 2019 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.
OBJECTIVE: Sleep disturbance may limit improvement in pain outcomes if not directly addressed in treatment. Moreover, sleep problems may be exacerbated by opioid therapy. This study examined the effects of baseline sleep disturbance on improvement in pain outcomes using data from the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial, a pragmatic 12-month randomized trial of opioid vs nonopioid medication therapy. DESIGN: Participants with chronic back pain or hip or knee osteoarthritis pain were randomized to either opioid therapy (N = 120) or nonopioid medication therapy (N = 120). METHODS: We used mixed models for repeated measures to 1) test whether baseline sleep disturbance scores modified the effect of opioid vs nonopioid treatment on pain outcomes and 2) test baseline sleep disturbance scores as a predictor of less improvement in pain outcomes across both treatment groups. RESULTS: The tests for interaction of sleep disturbance by treatment group were not significant. Higher sleep disturbance scores at baseline predicted less improvement in Brief Pain Inventory (BPI) interference (β = 0.058, P = 0.0002) and BPI severity (β = 0.026, P = 0.0164). CONCLUSIONS: Baseline sleep disturbance adversely affects pain response to treatment regardless of analgesic regimen. Recognition and treatment of sleep impairments that frequently co-occur with pain may optimize outcomes. 2019 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.
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