0911 Characterizing Sleep, Pain, and Opioid Craving in People with Chronic Low Back Pain on Long Term Opioid Therapy

Abstract Introduction Previous studies have demonstrated that long-term opioid use alters sleep architecture and continuity. Long-term opioid therapy (LTOT) is common amongst people with chronic pain, yet the interrelations of sleep and pain among patients on LTOT are poorly understood. Methods We characterized sleep amongst people with chronic low back pain (CLBP) on LTOT (n=53) using wireless sleep-electroencephalography (EEG), and ecological momentary assessment (EMA) in a naturalistic remote study. The relationships amongst the duration and percentages of rapid eye movement (REM) and slow wave sleep (SWS), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), pain, and opioid craving, measured using 14 days of EMA assessments were explored. Opioid craving was assessed through two questions which asked participants to rate how much they wanted to use opioids and the strength of their urge to use opioids. These items were averaged into one craving measure. Sleep-EEG data were averaged across two nights (when available) and separate linear regression analyses were used to determine the relationships between sleep predictors (architecture and continuity metrics) and 14-day averages of pain and opioid craving. Results Participants demonstrated poor sleep continuity, with substantial WASO (mean=148, SD=101 mins), short TSTs (mean=5.40, SD=2.16 hours), and low SE (mean=61.35%, SD=19.98%). However, REM% (mean=15.16%, SD=9.23%) and SWS% (mean=20.99%, SD=15.36%) were generally within normative ranges. Regression models demonstrated no significant relationship between the sleep architecture variables and pain or opioid craving. However, a strong positive correlation between pain and opioid craving (r=0.57, p< 0.01) was present. Conclusion Participants with CLBP on LTOT demonstrate poor sleep continuity, despite sleep architecture within normative ranges. Although we observed no relationship between sleep and pain or opioid craving, there was a strong relationship between pain and craving. Future studies should evaluate the temporal dynamics of sleep, pain, and opioid craving in this population, as well as the potential role of opioid dose and use patterns. Support (if any) NIH/NIDA R01DA048206