Pain never sleeps
Pain never sleeps: Why and how to integrate sleep management in the treatment for patients with chronic pain.
Pain never sleeps
Pain never sleeps: Why and how to integrate sleep management in the treatment for patients with chronic pain.
Chronic pain has a tremendous personal and socioeconomic impact. Lifestyle factors such as physical (in)activity, sedentary behaviour, stress, poor sleep, unhealthy diet and smoking are associated with chronic pain severity and sustainment1-5. This applies to all age categories, i.e. chronic pain across the lifespan. Yet current treatment options often do not, or only partly address the many lifestyle factors associated with chronic pain, or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention1,5-7. Therefore, this lecture focusses on one key lifestyle factor that is often overlooked and rarely addressed thoroughly: sleep.
Among many people with chronic pain, including patients with osteoarthritis, low back pain, neck pain, post-cancer pain, neuropathic pain, headache and fibromyalgia, insomnia is highly prevalent, closely related to the mechanism of central sensitization, characterized by low-grade neuroinflammation, commonly associated with stress or anxiety, and often does not respond effectively to drug treatments8. This lecture applies the current understanding of insomnia to clinical practice, including assessment and conservative treatment of insomnia in people with chronic pain9. Cognitive behavioural therapy for insomnia (CBT-I) can be efficacious in improvements of sleep initiation, sleep maintenance, perceived sleep quality and pain interference with daily functioning in people with chronic pain. With additional training, physiotherapist-led cognitive-behavioral interventions are efficacious for spinal pain, allowing their implementation within the field. CBT-I, as provided to people with chronic pain, typically includes sleep education, sleep restriction measures, stimulus control instructions, sleep hygiene, and cognitive therapy. This is an exciting, innovative area for the physiotherapy profession. This new development holds great potential for improving care for the many patients with persistent pain who have sleep problems.