A systematic review and meta-analysis found an improvement in subjective sleep measures associated with opioid therapies among patients with chronic low back pain (LBP). These findings were published in Sleep Medicine Reviews.
Investigators from The University of Sydney in Australia searched publication databases for studies focused on LBP, sleep, and pharmacological interventions. A total of 16 articles from 14 studies were included in this analysis.
The studies were conducted in North America (n=11) and Europe (n=3) and were of double-blind randomized (n=13) or single-blind (n=1) designs. The sample sizes ranged from 15 to 965 participants.
Opioid and nonopioid interventions were used in 12 and 2 studies, respectively. The 2 nonopioid studies used nonsteroidal anti-inflammatory drugs and the additive effect of an anti-convulsant for patients using opioids. The opioid interventions included buprenorphine transdermal patch, cebranopado, hydromorphone, morphine sulphate, novel full mu-opioid receptor antagonist, oxycodone, oxycontin, oxymorphone, tapentadol, and tramadol. All studies evaluated sleep using subjective questionnaires.
In the meta-analysis, opioids were found to improve sleep quality (standardized mean difference [SMD], 0.27; 95% CI, 0.17-0.36; P <.001). In sensitivity analyses, both the highest (SMD, 0.22; 95% CI, 0.12-0.32; P <.001) and lowest (SMD, 0.27; 95% CI, 0.17-0.37; P <.001) fixed dose regimens significantly improved sleep quality.
Similarly, sleep disturbance was improved with opioids (SMD, 0.32; 95% CI, 0.22-0.43; P <.001).
The major limitation of this study was that no comparison of opioids to nonopioids could be performed due to insufficient data.
Study authors concluded, “This review shows that opioid interventions improve sleep quality and reduce sleep disturbance in people with chronic LBP. Caution should be taken regarding these findings and in using opioids as their use exposes risks of misuse and dependency. This review included only 2 nonopioid studies. Without enough nonopioid studies to meta-analyze, we are unaware of whether nonopioid medications effect sleep in people with chronic LBP.”
Puterflam JM, Comis JJ, Lan Q, et al. The short-term effects of opioid and nonopioid pharmacotherapies on sleep in people with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2022;101672. doi:10.1016/j.smrv.2022.101672