Dear editor

I have thoroughly reviewed the article titled “The Combined Effect Between Sleep Disorders and Depression Symptoms on Chronic Low Back Pain: A Cross-Sectional Study of NHANES” and find it to be a valuable contribution to understanding the interplay between sleep disorders, depression, and chronic low back pain (CLBP).¹ However, I would like to offer some constructive feedback to further enhance the quality and robustness of the study.

Firstly, while the study accounts for several potential confounding factors, there may still be unidentified or inadequately controlled confounders. For example, lifestyle factors like diet and physical activity,² as well as social factors, including health policies³ and social isolation,⁴ could also play significant roles. Social determinants of health may interact with the risk of CLBP by influencing immune function, hormonal balance, and health behaviors, making them important mediators that warrant further investigation.

Secondly, the study may not have provided sufficient subgroup analyses to explore the specific effects of different backgrounds. The impact of race, gender, or more nuanced patient characteristics, such as socioeconomic status or marital status, on CLBP risk could yield valuable insights.¹ Conducting more in-depth subgroup analyses could help identify which specific populations are at greater risk of developing CLBP, thereby enabling more targeted prevention and intervention strategies.

To address these issues, future studies could integrate multidisciplinary approaches to pain management, particularly focusing on individualized care. For example, clinical interventions could include personalized pain management strategies that consider the combined effects of sleep disorders and depression. Healthcare providers, including mental health professionals and social workers, could play a vital role in designing and implementing these strategies. Such approaches could focus not only on improving physical health but also on addressing mental health and social barriers to ensure that CLBP patients receive comprehensive care. Moreover, enhancing patient education regarding sleep hygiene, mental well-being, and lifestyle modifications could further reduce the burden of CLBP, improve patient outcomes, and enhance overall quality of life.