{"doi":"10.1093/pm/pnad101","title":"Interactive effects of sleep disturbance and opioid use on pain-related interference and physical functioning among patients with chronic low back pain","abstract":"Dear Editor: Individuals with chronic low back pain (cLBP) show increased pain sensitivity and reduced physical functioning compared with healthy, pain-free adults.1 Patients with cLBP also report greater sleep disturbance,2 and sleep disturbance longitudinally predicts worse pain and impaired functioning.3 Opioids may be prescribed to help manage pain, and indeed, opioids have been shown to provide short-term pain relief, although these effects are modest and there is little to no impact on functional disability.4 Whereas some research suggests that opioids disrupt sleep patterns and contribute to poor sleep,5 other research indicates that opioids improve sleep, although observed effects are small.6 Less is known about how sleep disturbance and opioid use interact to impact pain and functioning. One study explored the interaction between sleep and opioid use on pain severity and pain interference among patients with chronic pain but did not find evidence of interactive effects.7 Importantly, that study excluded patients on long-term opioids, thereby excluding a subpopulation of patients. Additionally, patients in their study received medication management by a pharmacist, which is not standard in routine practice. Thus, more research is needed to understand the interactive effect of sleep disturbance and opioid use, specifically among patients with cLBP. In the present study, we examined associations among sleep disturbance, opioid use, physical functioning, and pain outcomes among patients with cLBP. We then explored whether opioids moderated the associations of sleep disturbance with physical functioning or pain outcomes. Participants were recruited through the Partners Healthcare Clinical Trials website, email, bulletin boards, the Internet, and electronic medical record databases from Brigham and Women’s Hospital and Massachusetts General Hospital from 2013 to 2020. Eligibility criteria included self-reported cLBP of ≥3 months’ duration, average pain rating ≥4/10, and no comorbid medical/pain conditions (eg, bipolar disorder, cancer). Participants provided informed consent, and the Partners Healthcare Institutional Review Board approved all study procedures. The Patient-Reported Outcomes Measurement Information System (PROMIS) short forms8 were used to measure pain severity, pain interference, physical functioning, and sleep disturbance. Participants also completed PROMIS measures of depression, anxiety, and fatigue. Scores were rescaled with the PROMIS score conversion table and converted to standardized T-scores (mean = 50, SD = 10).8 Participants also reported whether they used opioid medications for their back pain (no/yes) and provided demographic information. Participants (n = 213) were 42.8 years (SD = 13.3; range: 18–65 years) of age, and 58% were female. Participants were White (75%), African American / Black (12%), Asian (4%), American Indian / Alaska Native (0.5%), Native Hawaiian or Pacific Islander (0.5%), more than one race (4%), and 4% preferred not to answer. The majority of participants were non-Hispanic (90%). Of all participants, 87% provided their body mass index and had an average body mass index of 26.7 (SD = 5.4). Over the prior week, 57% of participants had used alcohol, 29% reported not using alcohol, and 14% did not report their alcohol use. Most participants were not current smokers (81%), 6% were current smokers, and 13% did not report their smoker status. Participant characteristics and associations of sleep, pain, physical function, opioid use, and psychological symptoms. n = 213. Means are reported as PROMIS T-scores (range: 0–100), except for pain severity (range: 0–10). Pearson correlations for continuous variables, P < .01, P < .001. t tests for categorical variables. For each categorical variable, means with different subscripts (a and b) indicate that the groups were significantly different from each other (P < .05). Pearson correlations and t tests were conducted to examine association","journal":"Pain Medicine","year":2023,"id":378805,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9624,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":898275,"name":"JiHee Yoon","orcid":"0000-0002-2440-1808","position":1,"is_corresponding":false},{"id":348424,"name":"Kristin L. Schreiber","orcid":"0000-0002-7361-2214","position":2,"is_corresponding":false},{"id":226954,"name":"Robert R. Edwards","orcid":"0000-0003-4873-0443","position":3,"is_corresponding":false},{"id":233894,"name":"Christine B. Sieberg","orcid":"0000-0003-1696-0340","position":4,"is_corresponding":false},{"id":634234,"name":"Samantha M. Meints","orcid":"0000-0002-6020-6671","position":5,"is_corresponding":false},{"id":875001,"name":"Jenna M. Wilson","orcid":"0000-0003-3154-0467","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-19T01:16:48.594070Z","pmid":"37467074","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}