Incidence and sociodemographic characteristics of coexisting function-limiting musculoskeletal problems and psychological distress among university students in Sweden: The SUN cohort study.

Patients with spinal metastases often experience substantial physiological and psychological stress due to tumor invasion, nerve compression, and persistent pain. Among various modifiable risk factors, preoperative fragmented sleep has gained increasing attention for its detrimental impact on surgical outcomes (, ). Studies indicate that approximately 65%–80% of these patients suffer from impaired sleep maintenance, characterized by frequent nocturnal awakenings and reduced sleep efficiency (, ). These disturbances not only exacerbate preoperative anxiety and pain sensitivity but also elevate the risk of postoperative complications, including delirium and infection. Despite the high prevalence of sleep disorders, perioperative management remains largely pharmacological, often relying on sedatives associated with adverse effects such as sedation, respiratory depression, and drug dependence—making them suboptimal choices for oncology patients. This underscores the urgent need for safe and effective non-pharmacological strategies to improve sleep quality in the perioperative period (, ). Fragmented sleep—defined as recurrent interruptions that prevent sustained restorative rest—is particularly common among patients with advanced cancer (, ). In those with spinal metastases, physical discomfort, psychological distress, and tumor-related symptoms contribute significantly to sleep disruption. Such fragmentation has been shown to impair immune function, heighten pain perception, and delay postoperative recovery. Emerging evidence suggests that the consequences of sleep disturbances in this population extend beyond the nighttime, affecting long-term emotional well-being, immunologic competence, and overall quality of life. Therefore, addressing fragmented sleep is critical to improving clinical outcomes and enhancing recovery in this vulnerable group. Mindfulness-Based Stress Reduction (MBSR), a structured program that incorporates mindfulness meditation and attentional training, has been widely used in oncology to provide psychological support and relieve pain (). Prior studies have shown that MBSR can significantly reduce anxiety and depressive symptoms while improving sleep quality in cancer patients (). However, most of this research has focused on general psychological benefits, with limited exploration of MBSR as a targeted intervention for preoperative sleep issues in patients with spinal metastases. Additionally, the conventional 8-week MBSR protocol may be impractical for patients awaiting imminent surgery, highlighting the need for a shorter, more adaptable version (–). Auricular acupressure, a non-invasive technique based on traditional Chinese medicine, presents a simple, low-risk, and patient-friendly complementary approach (–). In this study, we propose a combined intervention integrating short-term MBSR with auricular acupressure as a proactive strategy for managing preoperative sleep fragmentation. Delivered in multiple phases—outpatient prehabilitation, home-based practice, and inpatient reinforcement—this intervention aligns with the modern concept of perioperative “prehabilitation.” We hypothesize that this integrative approach offers a novel, non-pharmacological solution to enhance sleep quality and alleviate anxiety prior to surgery.