Sleep Disturbance Predicts Less Improvement in Pain Outcomes: Secondary Analysis of the SPACE Randomized Clinical Trial

Erin Koffel; Allyson M Kats; Kurt Kroenke; Matthew J Bair; Amy Gravely; Beth DeRonne; Melvin T Donaldson; Elizabeth S Goldsmith; Siamak Noorbaloochi; Erin E Krebs

doi:10.1093/pm/pnz221

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Sleep Disturbance Predicts Less Improvement in Pain Outcomes: Secondary Analysis of the SPACE Randomized Clinical Trial

Journal article

Open access

Peer reviewed

Sleep Disturbance Predicts Less Improvement in Pain Outcomes: Secondary Analysis of the SPACE Randomized Clinical Trial

Erin Koffel, Allyson M Kats, Kurt Kroenke, Matthew J Bair, Amy Gravely, Beth DeRonne, Melvin T Donaldson, Elizabeth S Goldsmith, Siamak Noorbaloochi and Erin E Krebs

Pain medicine (Malden, Mass.), Vol.21(6), pp.1162-1167

06/01/2020

DOI: 10.1093/pm/pnz221

PMCID: PMC7069777

PMID: 31529104

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069777View

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Abstract

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. 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). 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. 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). 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.

Analgesics - pharmacology

Humans

Osteoarthritis, Hip

Osteoarthritis, Knee

Sleep

Sleep Wake Disorders - drug therapy

Treatment Outcome

Details

Title: Subtitle: Sleep Disturbance Predicts Less Improvement in Pain Outcomes: Secondary Analysis of the SPACE Randomized Clinical Trial
Creators: Erin Koffel - Minneapolis VA Health Care System
Allyson M Kats - University of Minnesota
Kurt Kroenke - Indiana University – Purdue University Indianapolis
Matthew J Bair - Indiana University – Purdue University Indianapolis
Amy Gravely - Minneapolis VA Health Care System
Beth DeRonne - Minneapolis VA Health Care System
Melvin T Donaldson - University of Minnesota Medical Center
Elizabeth S Goldsmith - Minneapolis VA Health Care System
Siamak Noorbaloochi - Minneapolis VA Health Care System
Erin E Krebs - Minneapolis VA Health Care System
Resource Type: Journal article
Publication Details: Pain medicine (Malden, Mass.), Vol.21(6), pp.1162-1167
Publisher: Oxford University Press (OUP)
DOI: 10.1093/pm/pnz221
PMID: 31529104
PMCID: PMC7069777
ISSN: 1526-2375
eISSN: 1526-4637
Grant note: I01 HX000671 / HSRD VA T32 GM008244 / NIGMS NIH HHS F30 AT009162 / NCCIH NIH HHS
Language: English
Date published: 06/01/2020
Academic Unit: Emergency Medicine
Record Identifier: 9984656600802771

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