Of 679 nurses, no significant increase in pain complaints was found for five out of six anatomical regions after consecutive night shifts compared to morning shifts.
A strong trend suggested that headache risk increased on workday 3 versus workday 2 for night shifts (OR 1.13, 95% CI 0.99 to 1.28).
Considering sleep duration, the risk for headache was lowered (OR 0.37, 95% CI 0.17 to 0.81).
No evidence supported a higher risk for pain complaints after compared to morning shifts.
The analysis did not reveal any shift type by workday interaction for pain in neck/shoulder/upper back, upper extremities, low back, lower extremities, or abdomen.
Simplified
OBJECTIVES: To determine whether nurses working consecutive night shifts, or short transitions between shifts ( (QRs)), yielded higher risk for pain complaints when compared with regular morning shifts. Sleep duration was tested as a potential mediator.
DESIGN: Observational diary study.
SETTING: Random hospitals.
PARTICIPANTS: Nurses with three-shift rotation (morning, evening and night), n=679, 22-63 years old.
OUTCOMES MEASURES: Daily ratings of working hours, sleep and subjective pain complaints in six anatomical regions (head, neck/shoulder/upper back, upper extremity, low back, lower extremity and abdomen) for 28 days. In addition, we assessed demographics, habitual sleep and pain complaints, work and lifestyle factors. It was tested (1) whether the risk for pain complaints was higher after workday 3 versus after workday 2, and whether the difference was larger for consecutive night shifts versus consecutive morning shifts, and (2) whether the risk for pain complaints was higher after QRs versus after two morning shifts. Risk for pain complaints refers to combined increased risk for any pain and risk for increased intensity.
RESULTS: Adjusted analyses showed no shift type by workday interaction for pain complaints in the neck/shoulder/upper back, upper extremities, low back, lower extremities or abdomen. For headache, a strong trend indicated that the risk was higher on workday 3 compared with workday 2 for night shifts (OR 1.13, 95% CI 0.99 to 1.28). The risk was lowered if sleep duration was taken into account (OR 0.37, 95% CI 0.17 to 0.81). No conclusive support was found for the risk for pain complaints being higher after QRs, compared with after morning shifts.
CONCLUSIONS: For five of six pain complaints, the hypotheses were not supported by the current data. For headache, we found potential support for a sleep-relieving effect on headache after working several nights in a row. Pain complaints were not instigated or exacerbated by an evening-to-morning transition between shifts.
Key numbers
1.13
Adjusted Odds Ratio for Headache Risk Increase
Compared workday 3 to workday 2 for night shifts.
0.39
Lower Extremity Pain Odds Ratio
Adjusted analysis comparing night vs. morning shifts.
5.5 hours
Sleep Duration Comparison
Mean sleep duration reported after .
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