central sensitization; chronic pain; chronic spinal pain; insomnia; polysomnography; Leadership and Management; Health Policy; Health Informatics; Health Information Management
Abstract :
[en] [en] BACKGROUND: Chronic spinal pain (CSP) is a major public health problem worldwide, frequently related to sleep problems. Central sensitization (CS) may worsen the clinical picture of CSP patients with insomnia. The aim of this study was to compare self-reported and objectively measured clinical outcomes between insomniac CSP patients with comorbid insomnia with and without symptoms of CS.
METHODS: A case-control study on baseline self-reported sleep, functioning, and psychological distress through online questionnaires. Objective sleep and physical activity parameters and pressure pain thresholds (PPTs) were assessed through polysomnography, actigraphy, and digital algometry, respectively. Independent sample t-test and Mann-Whitney U tests were used to examine possible differences in the outcome measures between the groups.
RESULTS: Data from 123 participants were included and revealed no statistically significant group for objective sleep and physical activity parameters. The CS group, however, presented with worse self-reported sleep (quality sleep, insomnia severity, and dysfunctional beliefs about sleep), increased mental and physical fatigue, and higher psychological distress (anxiety and depressive symptoms), and reported lower PPTs.
CONCLUSIONS: symptoms of CS may influence perceived sleep and affect functional health and well-being perception but do not seem to affect objective sleep and physical activity.
Disciplines :
Orthopedics, rehabilitation & sports medicine
Author, co-author :
Araújo Almeida, Lucas ; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103-Building F, 1090 Brussel, Belgium ; Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos 13565-905, SP, Brazil ; Department of Physical Therapy, University of Florida, Gainesville, FL 32611, USA
Bilterys, Thomas ; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103-Building F, 1090 Brussel, Belgium ; Pain in Motion International Research Group, 1090 Brussel, Belgium ; Department of Psychology, University of Warwick, Coventry CV4 7AL, UK ; Institute of Advanced Study, University of Warwick, Coventry CV4 7AL, UK
Van Looveren, Eveline ; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103-Building F, 1090 Brussel, Belgium ; Pain in Motion International Research Group, 1090 Brussel, Belgium ; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans-Building B3, De Pintelaan 185, 9000 Ghent, Belgium
Mairesse, Olivier ; Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium
Cagnie, Barbara ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation ; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans-Building B3, De Pintelaan 185, 9000 Ghent, Belgium
Meeus, Mira ; Pain in Motion International Research Group, 1090 Brussel, Belgium ; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans-Building B3, De Pintelaan 185, 9000 Ghent, Belgium ; Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
Moens, Maarten ; Pain in Motion International Research Group, 1090 Brussel, Belgium ; Department of Neurosurgery and Radiology, University Hospital Brussels, 1090 Brussels, Belgium ; Stimulus Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium ; Center of Neurosciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium
Goubert, Dorien ; Pain in Motion International Research Group, 1090 Brussel, Belgium ; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans-Building B3, De Pintelaan 185, 9000 Ghent, Belgium
Munneke, Wouter ; Université de Liège - ULiège > Evaluation-Revalidation (EVAREVA) ; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103-Building F, 1090 Brussel, Belgium ; Pain in Motion International Research Group, 1090 Brussel, Belgium
Danneels, Lieven ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation ; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans-Building B3, De Pintelaan 185, 9000 Ghent, Belgium
Ickmans, Kelly ; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103-Building F, 1090 Brussel, Belgium ; Pain in Motion International Research Group, 1090 Brussel, Belgium ; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium ; Movement & Nutrition for Health & Performance Research Group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
Rezende Camargo, Paula; Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos 13565-905, SP, Brazil
Nijs, Jo ; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103-Building F, 1090 Brussel, Belgium ; Pain in Motion International Research Group, 1090 Brussel, Belgium ; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium ; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41390 Göterbog, Sweden
Malfliet, Anneleen ; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103-Building F, 1090 Brussel, Belgium ; Pain in Motion International Research Group, 1090 Brussel, Belgium ; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium ; Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
De Baets, Liesbet; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103-Building F, 1090 Brussel, Belgium ; Pain in Motion International Research Group, 1090 Brussel, Belgium
FAPESP - São Paulo Research Foundation NIH - National Institutes of Health FWO - Fonds Wetenschappelijk Onderzoek Vlaanderen
Funding text :
Funding: Lucas Araújo Almeida was funded by the São Paulo Research Foundation (FAPESP; Grant #2018/26103-4 and Grant #2021/09520-3) and received salary support from R01 AR080058 from the National Institute of Health. This study was funded by Fonds Wetenschappelijk Onderzoek— Toegepast Biomedisch Onderzoek (FWO–TBM, grant no. T001117N). The funder did not have any role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, approval, or submission of this study.Lucas Araújo Almeida was funded by the São Paulo Research Foundation (FAPESP; Grant #2018/26103-4 and Grant #2021/09520-3) and received salary support from R01 AR080058 from the National Institute of Health. This study was funded by Fonds Wetenschappelijk Onderzoek—Toegepast Biomedisch Onderzoek (FWO–TBM, grant no. T001117N). The funder did not have any role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, approval, or submission of this study.
Murray C.J.L. Vos T. Lozano R. Naghavi M. Flaxman A.D. Michaud C. Ezzati M. Shibuya K. Salomon J.A. Abdalla S. et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2197 2223 10.1016/S0140-6736(12)61689-4
Hoy D. Bain C. Williams G. March L. Brooks P. Blyth F. Woolf A. Vos T. Buchbinder R. A systematic review of the global prevalence of low back pain Arthritis Rheum. 2012 64 2028 2037 10.1002/art.34347
Fejer R. Kyvik K.O. Hartvigsen J. The prevalence of neck pain in the world population: A systematic critical review of the literature Eur. Spine J. 2006 15 834 848 10.1007/s00586-004-0864-4
Deyo R.A. Cherkin D. Conrad D. Volinn E. Cost, controversy, crisis: Low back pain and the health of the public Annu. Rev. Public Health 1991 12 141 156 10.1146/annurev.pu.12.050191.001041
Daffner S.D. Hilibrand A.S. Hanscom B.S. Brislin B.T. Vaccaro A.R. Albert T.J. Impact of neck and arm pain on overall health status Spine 2003 28 2030 2035 10.1097/01.BRS.0000083325.27357.39
Von Korff M. Crane P. Lane M. Miglioretti D.L. Simon G. Saunders K. Stang P. Brandenburg N. Kessler R. Chronic spinal pain and physical-mental comorbidity in the United States: Results from the national comorbidity survey replication Pain 2005 113 331 339 10.1016/j.pain.2004.11.010 15661441
Hartvigsen J. Hancock M.J. Kongsted A. Louw Q. Ferreira M.L. Genevay S. Hoy D. Karppinen J. Pransky G. Sieper J. et al. What low back pain is and why we need to pay attention Lancet 2018 391 2356 2367 10.1016/S0140-6736(18)30480-X 29573870
Tang N.K.Y. Wright K.J. Salkovskis P.M. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain J. Sleep Res. 2007 16 85 95 10.1111/j.1365-2869.2007.00571.x 17309767
Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences J. Clin. Sleep Med. 2007 3 (Suppl. S5) S7 10.5664/jcsm.26929
Sayar K. Arikan M. Yontem T. Sleep quality in chronic pain patients Can. J. Psychiatry 2002 47 844 848 10.1177/070674370204700905
Kim S.H. Lee D.H. Yoon K.B. An J.R. Yoon D.M. Factors Associated with Increased Risk for Clinical Insomnia in Patients with Chronic Neck Pain Pain Physician 2015 18 593 598 Available online: https://ir.ymlib.yonsei.ac.kr/handle/22282913/156955 (accessed on 1 September 2023)
Gerhart J.I. Burns J.W. Post K.M. Smith D.A. Porter L.S. Burgess H.J. Schuster E. Buvanendran A. Fras A.M. Keefe F.J. Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects Ann. Behav. Med. 2017 51 365 10.1007/s12160-016-9860-2
Kelly G.A. Blake C. Power C.K. Okeeffe D. Fullen B.M. The association between chronic low back pain and sleep: A systematic review Clin. J. Pain 2011 27 169 181 10.1097/AJP.0b013e3181f3bdd5 20842008
Neblett R. Cohen H. Choi Y. Hartzell M.M. Williams M. Mayer T.G. Gatchel R.J. The Central Sensitization Inventory (CSI): Establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample J. Pain 2013 14 438 445 10.1016/j.jpain.2012.11.012 23490634
Neblett R.M. Hartzell M.M. Cohen H. Mayer T.G. Williams M. Choi Y.M. Gatchel R.J.P. Ability of the central sensitization inventory to identify central sensitivity syndromes in an outpatient chronic pain sample Clin. J. Pain 2015 31 323 332 10.1097/AJP.0000000000000113
Neblett R. The central sensitization inventory: A user’s manual J. Appl. Biobehav. Res. 2018 23 e12123 10.1111/jabr.12123
Tang N.K.Y. Goodchild C.E. Sanborn A.N. Howard J. Salkovskis P.M. Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: A multilevel daily process study Sleep 2012 35 675 687 10.5665/sleep.1830
Haack M. Simpson N. Sethna N. Kaur S. Mullington J. Sleep deficiency and chronic pain: Potential underlying mechanisms and clinical implications Neuropsychopharmacology 2020 45 205 216 10.1038/s41386-019-0439-z
Roussel N.A. Nijs J. Meeus M. Mylius V. Fayt C. Oostendorp R. Central sensitization and altered central pain processing in chronic low back pain: Fact or myth? Clin. J. Pain 2013 29 625 638 10.1097/AJP.0b013e31826f9a71
Van Looveren E. Bilterys T. Munneke W. Cagnie B. Ickmans K. Mairesse O. Malfliet A. De Baets L. Nijs J. Goubert D. et al. The association between sleep and chronic spinal pain: A systematic review from the last decade J. Clin. Med. 2021 10 3836 10.3390/jcm10173836
Zusman M. Forebrain-mediated sensitization of central pain pathways: ‘non-specific’ pain and a new image for, M.T Man. Ther. 2002 7 80 88 10.1054/math.2002.0442 12151244
Alsaadi S.M. McAuley J.H. Hush J.M. Maher C.G. Prevalence of sleep disturbance in patients with low back pain Eur. Spine J. 2011 20 737 10.1007/s00586-010-1661-x 21190045
Smith M.T. Haythornthwaite J.A. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature Sleep Med. Rev. 2004 8 119 132 10.1016/S1087-0792(03)00044-3 15033151
Haack M. Scott-Sutherland J. Santangelo G. Simpson N.S. Sethna N. Mullington J.M. Pain sensitivity and modulation in primary insomnia Eur. J. Pain 2012 16 522 533 10.1016/j.ejpain.2011.07.007 22396081
Steinmetz A. Hacke F. Delank K.S. Pressure Pain Thresholds and Central Sensitization in Relation to Psychosocial Predictors of Chronicity in Low Back Pain Diagnostics 2023 13 786 10.3390/diagnostics13040786 36832274
Pedler A. Sterling M. Patients with chronic whiplash can be subgrouped on the basis of symptoms of sensory hypersensitivity and posttraumatic stress Pain 2013 154 1640 1648 10.1016/j.pain.2013.05.005 23707284
Aili K. Hillert L. Nyman T. Svartengren M. Sleep disturbances predict future sickness absence among individuals with lower back or neck-shoulder pain: A 5-year prospective study Scand. J. Public Health 2015 43 315 323 10.1177/1403494814567755
Malfliet A. Bilterys T. Van Looveren E. Meeus M. Danneels L. Ickmans K. Cagnie B. Mairesse O. Neu D. Moens M. et al. The added value of cognitive behavioral therapy for insomnia to current best evidence physical therapy for chronic spinal pain: Protocol of a randomized controlled clinical trial Braz. J. Phys. Ther. 2019 23 62 70 10.1016/j.bjpt.2018.10.007
Jungquist C.R. O’brien C. Matteson-Rusby S. Smith M.T. Pigeon W.R. Xia Y. Lu N. Perlis M.L. The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain Sleep Med. 2010 11 302 309 10.1016/j.sleep.2009.05.018
Dworkin R.H. Turk D.C. Farrar J.T. Haythornthwaite J.A. Jensen M.P. Katz N.P. Kerns R.D. Stucki G. Allen R.R. Bellamy N. et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations Pain 2005 113 9 19 10.1016/j.pain.2004.09.012
Smith M.T. Remeniuk B. Finan P.H. Speed T.J. Tompkins D.A. Robinson M. Gonzalez K. Bjurstrom M.F. Irwin M.R. Sex differences in measures of central sensitization and pain sensitivity to experimental sleep disruption: Implications for sex differences in chronic pain Sleep 2019 42 zsy209 10.1093/sleep/zsy209 30371854
Berry R.B. Brooks R. Gamaldo C. Harding S.M. Lloyd R.M. Quan S.F. Troester M.T. Vaughn B.V. AASM Scoring Manual Updates for 2017 (Version 2.4) J. Clin. Sleep Med. 2017 13 665 10.5664/jcsm.6576 28416048
Mathias J.L. Cant M.L. Burke A.L.J. Sleep disturbances and sleep disorders in adults living with chronic pain: A meta-analysis Sleep Med. 2018 52 198 210 10.1016/j.sleep.2018.05.023 30314881
Mollayeva T. Thurairajah P. Burton K. Mollayeva S. Shapiro C.M. Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis Sleep Med. Rev. 2016 25 52 73 10.1016/j.smrv.2015.01.009
Bastien C.H. Vallières A. Morin C.M. Validation of the insomnia severity index as an outcome measure for insomnia research Sleep Med. 2001 2 297 307 10.1016/S1389-9457(00)00065-4
Gagnon C. Bélanger L. Ivers H. Morin C.M. Validation of the Insomnia Severity Index in primary care J. Am. Board Fam. Med. 2013 26 701 710 10.3122/jabfm.2013.06.130064
Morin C.M. Vallières A. Ivers H. Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16) Sleep 2007 30 1547 1554 10.1093/sleep/30.11.1547
Lapin B.R. Bena J.F. Walia H.K. Moul D.E. The Epworth Sleepiness Scale: Validation of One-Dimensional Factor Structure in a Large Clinical Sample J. Clin. Sleep Med. 2018 14 1293 1301 10.5664/jcsm.7258
Buysse D.J. Reynolds C.F. Monk T.H. Berman S.R. Kupfer D.J. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research Psychiatry Res. 1989 28 193 213 10.1016/0165-1781(89)90047-4
Morin C.M. Belleville G. Bélanger L. Ivers H. The Insomnia Severity Index: Psychometric indicators to detect insomnia cases and evaluate treatment response Sleep 2011 34 601 608 10.1093/sleep/34.5.601
Fabbri M. Beracci A. Martoni M. Meneo D. Tonetti L. Natale V. Measuring Subjective Sleep Quality: A Review Int. J. Environ. Res. Public Health 2021 18 1082 10.3390/ijerph18031082
Bastien C.H. Morin C.M. Ouellet M.C. Blais F.C. Bouchard S. Cognitive-behavioral therapy for insomnia: Comparison of individual therapy, group therapy, and telephone consultations J. Consult. Clin. Psychol. 2004 72 653 659 10.1037/0022-006X.72.4.653
Kendzerska T.B. Smith P.M. Brignardello-Petersen R. Leung R.S. Tomlinson G.A. Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review Sleep Med. Rev. 2014 18 321 331 10.1016/j.smrv.2013.08.002
Martin J.L. Hakim A.D. Wrist Actigraphy Chest 2011 139 1514 10.1378/chest.10-1872 21652563
Aili K. Åström-Paulsson S. Stoetzer U. Svartengren M. Hillert L. Reliability of Actigraphy and Subjective Sleep Measurements in Adults: The Design of Sleep Assessments J. Clin. Sleep Med. 2017 13 39 47 10.5664/jcsm.6384 27707448
McHorney C.A. Ware J.E. Raczek A.E. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs Med. Care 1993 31 247 263 10.1097/00005650-199303000-00006 8450681
Bjelland I. Dahl A.A. Haug T.T. Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: An updated literature review J. Psychosom. Res. 2002 52 69 77 10.1016/S0022-3999(01)00296-3
Mairesse O. Damen V. Newell J. Kornreich C. Verbanck P. Neu D. The Brugmann Fatigue Scale: An Analogue to the Epworth Sleepiness Scale to Measure Behavioral Rest Propensity Behav. Slee. Med. 2019 17 437 458 10.1080/15402002.2017.1395336
Fischer A.A. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold Pain 1987 30 115 126 10.1016/0304-3959(87)90089-3 3614975
Chesterton L.S. Sim J. Wright C.C. Foster N.E. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters Clin. J. Pain 2007 23 760 766 10.1097/AJP.0b013e318154b6ae
Amiri M. Alavinia M. Singh M. Kumbhare D. Pressure Pain Threshold in Patients with Chronic Pain: A Systematic Review and Meta-Analysis Am. J. Phys. Med. Rehabil. 2021 100 656 674 10.1097/PHM.0000000000001603 33002911
Mayer T.G. Neblett R. Cohen H. Howard K.J. Choi Y.H. Williams M.J. Perez Y. Gatchel R.J. The development and psychometric validation of the central sensitization inventory Pain Pract. 2012 12 276 285 10.1111/j.1533-2500.2011.00493.x 21951710
Kregel J. Vuijk P.J. Descheemaeker F. Keizer D. van der Noord R. Nijs J. Cagnie B. Meeus M. van Wilgen P. The Dutch Central Sensitization Inventory (CSI): Factor Analysis, Discriminative Power, and Test-Retest Reliability Clin. J. Pain 2016 32 624 630 10.1097/AJP.0000000000000306 26418360
Heston T.F. King J.M. Predictive power of statistical significance World J. Methodol. 2017 7 112 116 10.5662/wjm.v7.i4.112 29354483
Woolf C.J. Central sensitization: Implications for the diagnosis and treatment of pain Pain 2011 152 (Suppl. S1) S2 S15 10.1016/j.pain.2010.09.030 20961685
Neblett R. Hartzell M.M. Mayer T.G. Cohen H. Gatchel R.J. Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory Pain Pract. 2017 17 166 175 10.1111/papr.12440
Chang J.R. Fu S.-N. Li X. Li S.X. Wang X. Zhou Z. Pinto S.M. Samartzis D. Karppinen J. Wong A.Y. The differential effects of sleep deprivation on pain perception in individuals with or without chronic pain: A systematic review and meta-analysis Sleep Med. Rev. 2022 66 101695 10.1016/j.smrv.2022.101695
Othman R. Jayakaran P. Swain N. Dassanayake S. Tumilty S. Mani R. Relationships Between Psychological, Sleep, and Physical Activity Measures and Somatosensory Function in People with Peripheral Joint Pain: A Systematic Review and Meta-Analysis Pain Pract. 2021 21 226 261 10.1111/papr.12943
Bilterys T. Van Looveren E. Malfliet A. Nijs J. Meeus M. Danneels L. Ickmans K. Cagnie B. Goubert D. Moens M. et al. Relationship, differences, and agreement between objective and subjective sleep measures in chronic spinal pain patients with comorbid insomnia: A cross-sectional study Pain 2023 164 2016 2028 10.1097/j.pain.0000000000002901
NICE Overview—Physical Activity: Exercise Referral Schemes—Guidance Available online: https://www.nice.org.uk/guidance/ph54 (accessed on 30 August 2023)
Hamer M. Ingle L. Carroll S. Stamatakis E. Physical activity and cardiovascular mortality risk: Possible protective mechanisms? Med. Sci. Sports Exerc. 2012 44 84 88 10.1249/MSS.0b013e3182251077
Koes B.W. Van Tulder M. Lin C.W.C. Macedo L.G. McAuley J. Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care Eur. Spine J. 2010 19 2075 10.1007/s00586-010-1502-y 20602122
Tesarz J. Schuster A.K. Hartmann M. Gerhardt A. Eich W. Pain perception in athletes compared to normally active controls: A systematic review with meta-analysis Pain 2012 153 1253 1262 10.1016/j.pain.2012.03.005 22607985
Sluka K.A. Frey-Law L. Bement M.H. Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation Pain 2018 159 (Suppl. S1) S91 S97 10.1097/j.pain.0000000000001235 30113953
De Zoete R.M.J. Chen K. Sterling M. Central neurobiological effects of physical exercise in individuals with chronic musculoskeletal pain: A systematic review BMJ Open 2020 10 e036151 10.1136/bmjopen-2019-036151
Blay S.L. Andreoli S.B. Gastal F.L. Chronic painful physical conditions, disturbed sleep and psychiatric morbidity: Results from an elderly survey Ann. Clin. Psychiatry 2007 19 169 174 10.1080/10401230701468099
Mork P.J. Vik K.L. Moe B. Lier R. Bardal E.M. Nilsen T.I.L. Sleep problems, exercise and obesity and risk of chronic musculoskeletal pain: The Norwegian HUNT study Eur. J. Public Health 2014 24 924 929 10.1093/eurpub/ckt198 24293504
Bilterys T. Siffain C. De Maeyer I. Van Looveren E. Mairesse O. Nijs J. Meeus M. Ickmans K. Cagnie B. Goubert D. et al. Associates of insomnia in people with chronic spinal pain: A systematic review and meta-analysis J. Clin. Med. 2021 10 3175 10.3390/jcm10143175
Louw A. Diener I. Butler D.S. Puentedura E.J. The Effect of Neuroscience Education on Pain, Disability, Anxiety, and Stress in Chronic Musculoskeletal Pain Arch. Phys. Med. Rehabil. 2011 92 2041 2056 10.1016/j.apmr.2011.07.198
Shigetoh H. Tanaka Y. Koga M. Osumi M. Morioka S. The Mediating Effect of Central Sensitization on the Relation between Pain Intensity and Psychological Factors: A Cross-Sectional Study with Mediation Analysis Pain Res. Manag. 2019 2019 3916135 10.1155/2019/3916135
Neblett R. Hartzell M.M. Williams M. Bevers K.R. Mayer T.G. Gatchel R.J. Use of the Central Sensitization Inventory (CSI) as a treatment outcome measure for patients with chronic spinal pain disorder in a functional restoration program Spine J. 2017 17 1819 1829 10.1016/j.spinee.2017.06.008
Finan P.H. Buenaver L.F. Runko V.T. Smith M.T. Cognitive-Behavioral Therapy for Comorbid Insomnia and Chronic Pain Sleep Med. Clin. 2014 9 261 10.1016/j.jsmc.2014.02.007 25477769
Walton D. Macdermid J. Nielson W. Teasell R. Nailer T. Maheu P. A descriptive study of pressure pain threshold at 2 standardized sites in people with acute or subacute neck pain J. Orthop. Sports Phys. Ther. 2011 41 651 657 10.2519/jospt.2011.3667 21885907
Den Boer C. Terluin B. van der Wouden J.C. Blankenstein A.H. van der Horst H.E. Tests for central sensitization in general practice: A Delphi study BMC Fam. Pract. 2021 22 206 10.1186/s12875-021-01539-0 34666688