Characteristics and predictors of prescription sleep medication use among veterans with chronic pain

Introduction:Sleep problems commonly co-occur with chronic pain and are associated with distress and impairment. While behavioral interventions are recommended, patients are more frequently prescribed sleep medications that carry potentially significant side effects (eg, sedation) that may worsen pain symptoms over time. Understanding patterns of sleep medication use is necessary for increasing appropriate treatments for sleep problems among patients with pain.Objectives:To understand the prevalence and clinical characteristics associated with sleep medication use among veterans with chronic pain.Methods:We conducted a retrospective secondary data analysis of Veterans Health Administration medical records and identified patients with a chronic pain diagnosis receiving care from October 2018 through September 2021. Using multivariate logistic regression, we examined associations between patient and clinical characteristics and sleep medication use.Results:Among all identified patients with chronic pain (N = 1,706,241), 38% carried a sleep disorder diagnosis and 19% were prescribed sleep medications. Sleep medications were prescribed in 42% of patients with insomnia and 14% of patients without active sleep problems. Insomnia, mental health comorbidities, and current or recent opioid therapy were associated with a greater likelihood of sleep medication use. Women and veterans with minoritized racial/ethnic identities were less likely to receive sleep medications compared to male and white veterans.Conclusion:While prescription sleep medication use is common in veterans with chronic pain, rates differed depending on race/ethnicity, mental health comorbidities, and opioid therapy. Findings highlight a need to further example drivers of differing prescription practices among different patient groups and increase access to first-line behavioral sleep treatments among patients with chronic pain.