Analysis of a rehabilitation study found that a remote care program to manage upper limb, neck, and back pain significantly improved pain-related sleep impairment.
Individuals with musculoskeletal pain and sleep disturbance showed significant improvements on both fronts after a 12-week remote digital pain management program, according to a new study of more than 5,000 individuals.
Previous research supports the effectiveness of remote digital therapy for musculoskeletal (MSK) pain, but data on the impact of such programs on the sleep disturbance that often accompanies MSK pain are lacking, wrote Justin K. Scheer, MD, resident in neurological surgery at the University of California, San Francisco, and colleagues.
Sleep disorders have been reported in approximately 72% of people with chronic back pain, 65% of those with rheumatoid arthritis, 70% of those with osteoarthritis, and 95% of those with fibromyalgia, wrote Scheer et al in their paper.
Digital Pain Management Protocol Analysis
Methods
The researchers conducted an ad hoc home-based digital pain management protocol analysis. The study population included 5,749 adults aged 18 years and older with MSK pain who also reported sleep disturbance. Of these, 1,724 had upper limb pain, and 4,025 had spine pain (neck and back). A total of 4,051 completed the 12-week digital pain management program.
The digital intervention included exercise, education, and cognitive behavioral therapy and involved an interface between the patient and a physical therapist. Patients used motion trackers and a dedicated tablet with a mobile app to monitor their progress and symptoms.
The primary outcome was sleeping disturbance at the end of the study, as measured by the sleep questions on three questionnaires: Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH), the Oswestry disability index (ODI), and the Neck Disability Index (NDI). Data were collected at baseline, and at 4, 8, and 12 weeks.
Secondary outcomes were the impact of the program on self-reported pain, anxiety, work productivity and activity, and engagement. The mean age of the participants was 50.8 years, 56.7% were women, and most (81.9%) were employed. Most participants were overweight, with a mean body mass index was 29.1 kg/m2.
Findings
After 12 weeks, study participants showed significant improvements from baseline across all clinical outcomes, with an average decrease in pain of 2.42 points.
Individuals with upper limb pain had the greatest improvements in sleep impairment; 56% reported total recovery. Among those with spine pain (neck and back), 24% reported total recovery in sleep impairment upon completion of the program.
Overall, secondary outcome measures improved after the program. Anxiety and depression decreased by 4.15 points and 4.42 points, respectively, from baseline. Work productivity improved by 15.32 points, and impairment in non-work-related activity improved by 19.48 points.
Practical Takeaways
The findings reflect previous studies supporting the value of exercise in improving MSK pain and sleep. Still, the current study is the first known to investigate the use of a completely remote intervention for MSK to improve sleep, according to the researchers.
The findings were limited by several factors, mainly the lack of a control group, the researchers noted. Other limitations include the use only of patients with health insurance through employers, which may limit generalizability, and the lack of long-term follow-up data.
Additional prospective, controlled studies are needed, particularly to better characterize sleep disturbance in MSK patients in a remote digital context, and to identify whether sleep improvements persist long-term.
However, the results suggest that a digital care program can effectively improve sleep for people with upper limb, back, and neck pain related to the musculoskeletal system, the researchers concluded.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888, or (516) 419-4480 for the Long Island office, to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
