The importance of sleep habits to pain.

Not too long ago, it was thought that the time of the day was imprinted on our body by a small subset of our genes. In the last few years, the importance of the time of day was increased when it was discovered that just about all of our genes follow circadian rhythms, the patterns of the day. Cortisol, the hormone that is often described as regulating stress, normally follows the clock. It peaks before we wake up and is at it's lowest level around midnight. Given this, it's often questioned if sleep habits effect health. Researchers in Finland found that insufficient quality or quantity of sleep as a 16 year old increased the likelihood of pain. There is a bit of a chicken and the egg issue with the question, as pain can lead to insomnia as well as bad sleep habits leading to bad health and pain. They believe their study sorted this out, and that poor sleep does lead to increases in neck pain, shoulder pain or back pain. Future studies will look at whether changing sleep habits is an effective way of preventing pain.

Poor quality sleep or insomnia due to pain is a common question that the other doctors and I at ABC clinics, located around the Washington DC region, ask about frequently, as it's a common reason for patients to come in. It's considered one of the measures of severity of pain, and a particularly miserable side effect to deal with. Very often your pain may helped by treatment, and there may be postions or techniques that make sleep easier even for quite painful conditions.

Eur Spine J. 2009 Nov 20. [Epub ahead of print]

Is insufficient quantity and quality of sleep a risk factor for neck, shoulder and low back pain? A longitudinal study among adolescents.

Auvinen JP, Tammelin TH, Taimela SP, Zitting PJ, Järvelin MR, Taanila AM, Karppinen JI.

Finnish Institute of Occupational Health, Aapistie 1, 90220, Oulu, Finland, juhaauvi@mail.student.oulu.fi.

The quantity and quality of adolescents' sleep may have changed due to new technologies. At the same time, the prevalence of neck, shoulder and low back pain has increased. However, only a few studies have investigated insufficient quantity and quality of sleep as possible risk factors for musculoskeletal pain among adolescents. The aim of the study was to assess whether insufficient quantity and quality of sleep are risk factors for neck (NP), shoulder (SP) and low back pain (LBP). A 2-year follow-up survey among adolescents aged 15-19 years was (2001-2003) carried out in a subcohort of the Northern Finland Birth Cohort 1986 (n = 1,773). The outcome measures were 6-month period prevalences of NP, SP and LBP. The quantity and quality of sleep were categorized into sufficient, intermediate or insufficient, based on average hours spent sleeping, and whether or not the subject suffered from nightmares, tiredness and sleeping problems. The odds ratios (OR) and 95% confidence intervals (CI) for having musculoskeletal pain were obtained through logistic regression analysis, adjusted for previously suggested risk factors and finally adjusted for specific pain status at 16 years. The 6-month period prevalences of neck, shoulder and low back pain were higher at the age of 18 than at 16 years. Insufficient quantity or quality of sleep at 16 years predicted NP in both girls (OR 4.4; CI 2.2-9.0) and boys (2.2; 1.2-4.1). Similarly, insufficient sleep at 16 years predicted LBP in both girls (2.9; 1.7-5.2) and boys (2.4; 1.3-4.5), but SP only in girls (2.3; 1.2-4.4). After adjustment for pain status, insufficient sleep at 16 years predicted significantly only NP (3.2; 1.5-6.7) and LBP (2.4; 1.3-4.3) in girls. Insufficient sleep quantity or quality was an independent risk factor for NP and LBP among girls. Future studies should test whether interventions aimed at improving sleep characteristics are effective in the prevention and treatment of musculoskeletal pain.