An increasingly common clinical conversation

What clinical conversations do you find yourself repeating several times a week?

I seem to have two common themes at the moment. The first goes like this: "As we age, we naturally lose strength and mitochondrial function (but gain grey hair, wrinkles, and wisdom!), so if you want to pick up your grandkids, cast a fishing rod, or be able to wipe your backside, then you need to incorporate weight-resisted exercises. Are you?"

The second theme revolves around the multifacets influencing pain. 'So you have seen several other therapists, lots of massage, exercise, dry needling and here you are with me, are you looking for a longer term approach? If yes, let's explore your sleep routine and sleep system"

A good SR article has been published on this second conversation, pointing us towards the importance of this clinical conversation. You can read it in full here Sleep and chronic spinal pain_Looveren 2021.pdf

This systematic review explores the bidirectional relationship between sleep and chronic spinal pain (CSP), including chronic low back pain (CLBP) and chronic neck pain (CNP). The findings confirm that sleep disturbances—including poor sleep quality, reduced sleep duration, and insomnia—are strongly associated with increased pain intensity in CSP patients. The study also reinforces the concept that sleep dysfunction contributes to heightened pain sensitivity, likely due to neurobiological and inflammatory mechanisms. Importantly, the review suggests that sleep issues may be a stronger predictor of chronic pain development than pain is of sleep disturbances. The authors highlight that previous research lacked a comprehensive review of sleep's role in CNP, and this study addresses that gap.

Strengths:

• The review builds on prior research and updates findings with recent literature, addressing an important knowledge gap, particularly regarding CNP.
• A systematic methodology following PRISMA guidelines strengthens the credibility of the findings.
• The review includes cross-sectional and longitudinal studies, improving the depth of evidence regarding the sleep-pain relationship.
• Psychological and neurobiological mechanisms are discussed, adding valuable insights into why sleep disturbances exacerbate pain.

Weaknesses:

• The review relies heavily on subjective sleep assessments (questionnaires) and limited use of objective measures like polysomnography, a common problem.
• Variability in study designs, assessment tools, and definitions of CSP and sleep disorders makes it difficult to synthesize findings into a meta-analysis. This is a common problem.
• Many included studies were cross-sectional, limiting the ability to conclude causality between sleep disturbances and CSP.
• Potential confounders, such as medication use and comorbid conditions (e.g., obesity), were not consistently accounted for across studies.

Relevance to Sleep Educators:
This review highlights the crucial role of sleep quality in pain management, reinforcing the importance of educating CSP patients on sleep hygiene, behavioural sleep interventions, and cognitive strategies to enhance rest. Sleep educators should recognise that addressing insomnia and other sleep disturbances could be a vital component of a multimodal approach to managing chronic pain. The findings also support the integration of sleep assessments into clinical practice for pain management, emphasising the necessity for multidisciplinary collaboration between sleep specialists, physiotherapists, and pain management professionals.

Sleep is a new topic for many, and including it in clinical conversations can be daunting. Knowing what to ask, how much detail to provide, and what screening questions to ask can be daunting. I get it. Before completing my PhD in sleep science, I was the same. To assist other clinicians in making a quicker transition into sleep educators, I created the online course Sleep Mastery. You can find out more about the course here.