Prolonged Prescription Rates of Z-Hypnotics Among Individuals with Chronic Musculoskeletal Pain and Insomnia: The...

Musculoskeletal pain and insomnia frequently co-occur. Although insomnia is often treated with hypnotics, prolonged use is not recommended. The prevalence of prolonged hypnotic prescriptions among individuals with both conditions remains unknown. This descriptive epidemiological study aimed to estimate prolonged prescriptions among individuals with insomnia and chronic musculoskeletal pain.

In this cross-sectional study, data from 40,790 participants in the Trøndelag Health Study (HUNT4) were linked to the Norwegian Prescription Database for Z-hypnotic prescriptions during the participation year. Prolonged prescriptions were defined as ≥90 defined daily doses. Prevalence estimates were calculated by insomnia and chronic pain status, stratified by age, sex, and pain severity.

Among participants with insomnia, prolonged prescription prevalence was higher in those with chronic pain (12.9%) compared to insomnia alone (8.7%). Stratification revealed marked age and sex differences: women aged 45-69 had prevalences of 13.7% if they had pain and insomnia versus 10.2% if they had insomnia alone, increasing to 31.1% and 25.3% for women ≥70 years. For men, rates were 8.1% versus 9.3% at ages 45-69 years and 19.2% versus 14.9% at ≥70 years. Younger participants had prevalences between 1.4% and 2.7%. Pain severity influenced prevalence only among participants aged ≥70 years, and more strongly among men (22.5% with high impact pain versus 14.9% without pain).

Chronic musculoskeletal pain was associated with higher prescription rates, though not statistically significant within age categories, and pain severity had some influence among older individuals. Regardless of pain status, prolonged Z-hypnotic prescriptions increased with age, with women receiving more than men.