Chronic Low Back Pain May be Linked to Anxiety, Depression, or Sleep Disorders

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A study presented at EULAR 2024 found anxiety, depression, and sleep disorders were significantly correlated to pain intensity.

A study suggests chronic low back pain may be linked to anxiety-depressive and sleep disorders.1 A poster on the research was presented at the 2024 European Alliance of Associations for Rheumatology (EULAR) from June 12 – June 15 in Vienna, Austria.

Chronic low back pain not only brings a significant economic and social impact but can worsen other comorbidities. Back pain hinders sleep, and in return, poor sleep can impact an individual’s mental health. Insomnia is a common co-morbidity of back pain, and 1 study showed an increase in insomnia symptoms was linked to a 1.40-fold increased risk of back pain, suggesting insomnia was a risk factor for the development of back pain—not the other way around.2

Mayo Clinic shares on its website tips for sleeping positions to take the strain off the back, such as sleeping on your side with a pillow between your legs, sleeping on your back with a pillow under your knees, and avoiding sleeping on your stomach but if you need to can put a pillow under your hips and lower stomach.3 According to the Sleep Foundation, a good sleep position is vital for spinal alignment and a poor sleep posture can increase pressure on the lumbar spine.4

Although back pain has been acknowledged to impact sleep and mental health, investigators, led by Leila Rouached, from the Charles Nicolle Hospital in Tunis, Tunisia, aimed to assess the association of chronic low back pain with sleep and anxiety-depressive disorders.

Rouached and colleagues conducted a cross-sectional study in the rheumatology department of Charles Nicolle Hospital from November 2022 to December 2023. The team assessed for anxiety-depressive and sleep disorders using the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI), respectively. A PSQI score of ≥ 5 indicated poor sleep quality.

The study included 85 male patients with chronic low back pain. Patients had a mean age of 53 ± 13 years and a mean disease duration of 1 year. The sample included 42% sedentary patients and 57% smokers with an average of 23 pack-years.

Most patients (60%) had low back pain with radiculopathy. Among the participants, the S1 (31%) and L5 (27%) nerve roots had the most involvement. Abnormalities responsible for low back pain or lumbosciatica included staged degenerative discopathy (32%), disc herniation (28%), the narrow lumbar canal (15%), scoliosis (9%), Scheuermann’s disease (3%), and vertebral fracture (2%).

The team assessed pain with the visual analog scale and neurologic pain with the DN4 score. Participants had a mean visual analog scale of 60 out of 100 and a mean DN4 score of 2.1 out of 8.

Investigators observed anxiety in 40% of patients and major depressive syndrome in 27% of patients. Additionally, a mean PSQI score of 9 out of 21 indicated a patient had a sleep disorder.

The analysis showed anxiety-depressive disorders in patients with low back pain were linked to the sedentary lifestyle (P = .03) and smoking (P = .01). Sleep disorders were significantly correlated with pain intensity (P < .01) and neuropathic pain (P = .05). Additionally, HADS and PSQI scores were significantly correlated (P < .01).

“In our study, chronic low back pain may be associated with anxiety-depressive disorders and sleep disorders,” investigators concluded. “The management of these patients involves systematic screening for these comorbidities to reduce their psychosocial impact.”


  1. Rouached L, Ben Messaoud M, Bjeoui T, et al AB0155 SLEEP AND ANXIETY-DEPRESSIVE DISORDERS IN CHRONIC LOW BACK PAIN PATIENTS Annals of the Rheumatic Diseases 2024;83:1312.
  2. Agmon M, Armon G. Increased insomnia symptoms predict the onset of back pain among employed adults. PLoS One. 2014;9(8):e103591. Published 2014 Aug 1. doi:10.1371/journal.pone.0103591
  3. Sleeping Positions That Reduce Back Pain. Mayo Clinic.,much%20strain%20on%20your%20back. Accessed June 28, 2024.
  4. Suni, E and Iyo J. How to Sleep with Lower Back Pain: Finding Comfort and Relief. Sleep Foundation. April 10, 2024. Accessed June 28, 2024.