CBT May Help Break Vicious Cycle of Insomnia & Chronic Pain

By Rick Nauert PhD

Researchers from the University of Warwick Sleep and Pain Lab show in a new study that conditions like back pain, fibromyalgia, and arthritis are linked with negative thoughts about insomnia and pain — and this double whammy can be effectively managed by cognitive-behavioral therapy (CBT).

In the research, Esther Afolalu and colleagues developed a pioneering scale to measure beliefs about sleep and pain in long-term pain patients, alongside their quality of sleep. This method of quantification is the first of its type to combine both pain and sleep and investigate the vicious cycle between sleep and pain problems.

“Current psychological treatments for chronic pain have mostly focused on pain management and a lesser emphasis on sleep, but there is a recent interest in developing therapies to tackle both pain and sleep problems simultaneously,” Afolalu said. “This scale provides a useful clinical tool to assess and monitor treatment progress during these therapies.

The scale was tested on four groups of patients suffering from long-term pain and bad sleeping patterns, with the result showing that people who believe they won’t be able to sleep as a result of their pain are more likely to suffer from insomnia, thus causing worse pain.

The results show that the scale was vital in predicting patients’ level of insomnia and pain difficulties. With better sleep, pain problems are significantly reduced, especially after receiving a short course of CBT for both pain and insomnia.

The study has provided therapists the means with which to identify and monitor rigid thoughts about sleep and pain that are sleep-interfering, allowing the application of the proven effective CBT for insomnia in people with chronic pain.

“Thoughts can have a direct and/or indirect impact on our emotion, behavior and even physiology. The way how we think about sleep and its interaction with pain can influence the way how we cope with pain and manage sleeplessness,” said Dr. Nicole Tang, the senior author.

“Based on clinical experience, whilst some of these beliefs are healthy and useful, others are rigid and misinformed. The new scale, PBAS, is developed to help us pick up those beliefs that have a potential role in worsening the insomnia and pain experience,” Tang said.

The study appears in the Journal of Clinical Sleep Medicine.