Rest Assured: Tackling the Twists and Turns of Low Back Pain and Sleep Disturbance

Abstract

This thesis explores the bidirectional relationship of chronic low back pain (LBP) and sleep disturbance. This thesis also highlights digital health interventions (DHI) as a possible clinical tool for delivering therapies for sleep disturbance in people with chronic LBP. Chapter 2 is a literature review of chronic LBP, sleep disturbance, and the current landscape of digital health. Chapter 3 is a published systematic review and meta-analysis of pharmacotherapies for chronic LBP and their effect on sleep. The meta-analysis revealed that opioid treatments are associated with subjective improvements to sleep quality and sleep disturbance compared to placebo-control. Additionally, it was found that objective assessment of sleep is largely unexplored in chronic LBP. Chapter 4 is a mixed method manuscript, currently under peer-review. The survey (n=669) and interviews (n=26) exploring attitudes and experiences of people with chronic LBP towards healthcare for LBP, sleep disturbance, and digital health. This study found that LBP-related sleep disturbance is prevalent (90%, n = 600) and that this population is willing to use DHIs for their healthcare needs. Chapter 5 presents feasibility data at 6-months from an ongoing randomized controlled trial assessing the efficacy of a digital behavioural therapy for insomnia in people with chronic LBP and insomnia. Chapter 6 synthesizes the research findings and provides future directions. Research is required that further investigates the physiological underpinnings between chronic LBP and sleep disturbance particularly through objective measures of sleep. Additionally, feasibility and efficacy of DHIs in LBP populations should be assessed in clinical care settings to demonstrate the translatability of DHIs to clinical practice. Overall, sleep disturbance is a prevalent issue for individuals with chronic LBP and improved access sleep-related healthcare, through DHIs, is something that this population would benefit from.