Cognitive-Behavioral Therapy for Sleep Abnormalities of Chronic Pain Patients

Nicole Tang, MD

Department of Psychology
Institute of Psychiatry
King’s College London
London, United Kingdom

Chronic pain is a biopsychosocial condition that adversely affects multiple domains, including sleep. In fact, most chronic pain patients report fragmented or poor quality sleep. Moreover, studies suggest that pain onset often precedes the development of clinical insomnia, and pain intensity correlates with the degree of sleep disturbance. On the other hand, if left untreated, insomnia can potentiate pain, indicating that the relationship between pain and impaired sleep is complex. Importantly, an accurate assessment of sleep patterns can guide individualized chronic pain management. A number of clinical trials have demonstrated the benefits of cognitive behavioral therapy (CBT) for patients with chronic pain. These treatment approaches, such as relaxation training, meditation, and goal setting, are often tailored for specific chronic pain conditions. Unexpectedly, however, sleep symptoms frequently do not improve. On the other hand, studies examining CBT directed at pain-related insomnia show significant improvements in sleep quality without marked benefits for pain—surprising results given the presumed reciprocal relationship between sleep and pain. The results highlight the need for multimodal management strategies that not only address pain but also promote restorative sleep.

References

Tang NKY. Cognitive-behavioral therapy for sleep abnormalities of chronic pain patients. Curr Rheumatol Rep. 2009;11(6):451-460.
Jungquist CR, O'Brien C, Matteson-Rusby S, et al. The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain. Sleep Med. 2010;11(3):302-309.
Edinger JD, Wohlgemuth WK, Krystal AD, Rice JR. Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial. Arch Intern Med. 2005;165(21):2527-2535.

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