Morning Bright Light Treatment for Chronic Low Back Pain: Potential Impact on the Volatility of Pain, Mood, Function, and Sleep.
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ABSTRACT: Objectives
Most treatment outcome studies for people with chronic low back pain (CLBP) have based analyses on and reported only the mean levels of these factors. However, high levels of pain, mood, function, and sleep volatility may represent unique factors contributing to diminished quality of life. Our goal was to determine whether bright light treatment affected both mean levels of pain, mood, function, and sleep and reduced volatility in these outcomes.Methods
US military veterans with CLBP (N = 22) underwent an open trial with a seven-day baseline, followed by 13 days of a one-hour morning bright light treatment self-administered at their home and a 30-day follow-up. Participants completed daily diary measures at 12 Pm and 6 Pm every day during the three study epochs.Results
Using location scale modeling, results suggested that, in addition to being associated with changes in mean levels of pain intensity, pain interference, negative affect, and sleep quality, bright light treatment was also related to reductions in the volatility of pain intensity and negative affect, reductions that were largely maintained during follow-up.Conclusions
Changes in mean levels and volatility were independent factors, suggesting that bright light treatment was related to participants experiencing fewer "pain flares." These findings underscore the potential importance of volatility as a future treatment target.
SUBMITTER: Burns JW
PROVIDER: S-EPMC7286808 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundPoor sleep is common among adults with chronic low back pain (cLBP), but the influence of cLBP treatments, such as yoga and physical therapy (PT), on sleep quality is under studied.ObjectiveEvaluate the effectiveness of yoga and PT for improving sleep quality in adults with cLBP.DesignSecondary analysis of a randomized controlled trial.SettingAcademic safety-net hospital and 7 affiliated community health centers.ParticipantsA total of 320 adults with cLBP.InterventionTwelve weekly yoga classes, 1-on-1 PT sessions, or an educational book.Main measuresSleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) global score (0-21) at baseline, 12 weeks, and 52 weeks. Additionally, we also evaluated how the proportion of participants who achieved a clinically meaningful improvement in sleep quality (>?3-point reduction in PSQI) at 12 weeks varied by changes in pain and physical function at 6 weeks.Key resultsAmong participants (mean age?=?46.0, 64% female, 82% non-white), nearly all (92%) reported poor sleep quality (PSQI >?5) at baseline. At 12 weeks, modest improvements in sleep quality were observed among the yoga (PSQI mean difference [MD]?=?-?1.19, 95% confidence interval [CI] -?1.82, -?0.55) and PT (PSQI MD?=?-?0.91, 95% CI -?1.61, -?0.20) groups. Participants who reported a ??30% improvement in pain or physical function at 6 weeks, compared with those who improved <?10%, were more likely to be a sleep quality responder at 12 weeks (odds ratio [OR]?=?3.51, 95% CI 1.73, 7.11 and OR?=?2.16, 95% CI 1.18, 3.95, respectively). Results were similar at 52 weeks.ConclusionIn a sample of adults with cLBP, virtually all with poor sleep quality prior to intervention, modest but statistically significant improvements in sleep quality were observed with both yoga and PT. Irrespective of treatment, clinically important sleep improvements at the end of the intervention were associated with mid-intervention pain and physical function improvements.Trial registrationClinicalTrials.gov Identifier: NCT01343927.
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