Nature and nurture. Genetic and environmental factors on the relationship between back pain and sleep quality

Juan J. Madrid-Valero*, Alessandro Andreucci, Eduvigis Carrillo, Paulo H. Ferreira, Jose M. Martínez-Selva, Juan R. Ordoñana*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

2 Citations (Scopus)
35 Downloads (Pure)


BACKGROUND: Chronic low back pain (LBP), neck pain (NP), and sleep quality (SQ) are genetically influenced. All three conditions frequently co-occur and shared genetic aetiology on a pairwise base has been reported. However, to our knowledge, no study has yet investigated if these three conditions are influenced by the same genetic and environmental factors and the extent and pattern of genetic overlap between them, hence the current research.

METHODS: The sample included 2134 participants. Lifetime prevalence of NP and LBP were assessed through a dichotomous self-reported question derived from the Spanish National Health Survey. SQ was measured using the Pittsburgh Sleep Quality Index Questionnaire. A common pathway model with sleep quality and back pain as latent factors was fitted.

RESULTS: Our results highlight that a latent back pain factor, including both NP and LBP, is explained by both genetic (41%) and environmental (59%) factors. There are also significant unique environmental factors for NP (33%) and LBP (37%) respectively. Yet, specific genetic factors were scant (9%) for NP and negligible for LBP (0%). Genetic and environmental factors affecting SQ only contribute with 3% and 5% of the variance, respectively, to the common latent back pain variable.

CONCLUSIONS: NP and LBP share most of their genetic variance, while environmental effects show greater specificity for each of the back pain locations. Associations with SQ were of a limited magnitude.

SIGNIFICANCE: Our results confirm a significant association between both chronic NP and LBP and sleep quality. Such relationship comprises both genetic and environmental factors, with a greater relative weight of the latter. A large part of the individual variance for chronic LBP and chronic NP can be accounted for by a latent common factor of 'back pain'. Genetic influences for LBP and NP were mainly shared. However, environmental influences were common for both problems and specific for each of them in similar magnitudes.

Original languageEnglish
JournalEuropean Journal of Pain
Issue number7
Pages (from-to)1460-1468
Number of pages9
Publication statusPublished - Aug 2022

Bibliographical note

© 2022 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.


  • Chronic Pain/complications
  • Health Surveys
  • Humans
  • Low Back Pain/epidemiology
  • Neck Pain/epidemiology
  • Sleep Quality


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