• Raul Marin, Tamara Cyhan, and Wendy Miklos.
• Physical Medicine & Rehabilitation Service, Department of Orthopedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC, USA.
• Am J Phys Med Rehabil. 2006 May 1;85(5):430-5.

ObjectiveTo document the relationship between sleep disturbance and chronic low back pain in patients referred to a physical medicine and rehabilitation clinic.DesignThis is a prospective cross-sectional survey of 268 patients 18 yrs or older being evaluated for low back pain of greater than 6 months at a tertiary medical center. The survey consisted of a 43-item composite form that contained the Short-Form McGill Pain Questionnaire (SF-MPQ); the Pittsburgh Sleep Quality Index (PSQI); a pain visual analog scale (VAS); and questions regarding bed type, sleep position, and patients' sleep description.ResultsThere was a significant relationship between pain and sleep (P<0.0005) with a 55% increase in the proportion of subjects reporting restless/light sleep after pain onset. There was no corresponding increase in sleep medication use. There was a significant direct correlation between SF-MPQ and PSQI (r=0.44, P<0.0005); between PSQI and VAS (r=0.41, P<0.0005); and between overall quality of sleep and VAS (r=0.31, P<0.0005). Finally, PSQI scores were the worst in subjects sleeping on an orthopedic mattress (P=0.001).ConclusionsChronic low back pain significantly affects quality of sleep. Sleep problems should be addressed as an integral part of the pain management plan.

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