The effect of insomnia on physical therapy outcomes in patients with cervical and lumbar pain in clinical practice

[M. Đorđić]

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Nesanica je jedan od najčešće prijavljenih komorbiditeta kod hroničnog bola u kičmi. Međutim, osnovni mehanizmi koji objašnjavaju odnos između sna i bola još uvek nisu u potpunosti shvaćeni. Cilj istraživanja je bio da utvrdi razlike u ishodima fizikalne terapije i kvaliteta života kod pacijenata sa cervikalnim i/ili lumbalnim bolom koji imaju nesanicu u odnosu na pacijente bez nesanice tokom dvonedeljnog perioda aktivnog tretmana u uslovima rutinske kliničke prakse. Kao istraživački alati korišćeni su: upitnik o socio-demografskim karakteristikama ispitanika, Kratki oblik Mek-Gilovog upitnika o bolu (The McGill Pain Questionnaire, Short Form; SF-MPQ), Indeks težine nesanice (Insomina Severity Index-ISI) i Evropski upitnik za kvalitet života (European Quality of Life- EuroQol; EQ-5D). Rezutati su pokazali da se na kraju posete tretmanu, kod pacijenata obe studijske grupe pojavio se značajan odgovor na lečenje u skoro svim domenima istraživanja. Na kraju posete tretmanu, nivo bola ostaje nešto viši kod ispitanika eksperimentalne grupe, ali je statistička značajnost početne razlike nestala zbog većeg relativnog odgovora na terapiju u kontrolama (mereno procentom promene od početne vrednosti). Tretman je poboljšao kvalitet života pacijenata mnogo više kod eksperimentalnih nego kod kontrolnih subjekata, što je dokazano statistički značajnom razlikom u procentu promene u odnosu na početne vrednosti (približno 31% naspram približno 14). Saznanja o povezanosti bola i nesanice u praksi fizikalne medicine i rehabilitacije su od velikog značaja za kreiranje mera prevencije i adekvatne terapije za pacijenate sa bolnim sindromima.

Insomnia is one of the most commonly reported comorbidities in chronic spinal pain. However, the underlying mechanisms explaining the relationship between sleep and pain are still not fully understood. The aim of the study was to determine the differences in physical therapy outcomes and quality of life in patients with cervical and/or lumbar pain who have insomnia compared to patients without insomnia during a two-week active treatment period in routine clinical practice. The following research tools were used: a questionnaire on sociodemographic characteristics of the subjects, the McGill Pain Questionnaire, Short Form (SFMPQ), the Insomnia Severity Index (ISI), and the European Quality of Life Questionnaire (EuroQol; EQ-5D). The results showed that at the end of the treatment visit, patients in both study groups showed a significant response to treatment in almost all study domains. At the end of the treatment visit, pain levels remained slightly higher in the experimental group, but the statistical significance of the initial difference disappeared due to the greater relative response to therapy in the controls (measured as a percentage change from baseline). The treatment significantly improved the quality of life of patients in the experimental than in the control subjects, as evidenced by a statistically significant difference in the percentage change from baseline (approximately 31% versus approximately 14%). Knowledge about the relationship between pain and insomnia in the practice of physical medicine and rehabilitation is of great importance for the creation of methods of prevention and adequate therapy of patients with pain syndrome.

bol, nesanica, SF-MPQ, EQ-5D, cervikalni bol, lumbalni bol

pain, insomnia, SF-MPQ, EQ-5D, cervical pain, lumbar pain

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