By Pat Anson, Editor
British researchers say cognitive behavioral therapy can effectively treat insomnia in chronic pain patients – reducing their pain, fatigue and depression. But the therapy works best when delivered in person.
Cognitive behavioral therapy (CBT) is a form of psychotherapy, in which a therapist works with a patient to reduce unhelpful thinking and behavior. Poor sleep habits and insomnia have long been known to aggravate chronic pain conditions.
Researchers at the University of Warwick analyzed 72 studies involving over 1,000 patients who suffered from insomnia and chronic pain, and found that CBT was “moderately or strongly effective” in treating insomnia. The study has been published in the journal Sleep.
"This study is particularly important because the use of drugs to treat insomnia is not recommended over a long period of time, therefore the condition needs to be addressed using a non-pharmacological treatment,” said lead researcher Dr. Nicole Tang of the University of Warwick’s Department of Psychology.
"Poor sleep is a potential cause of ill health and previous studies suggest it can lead to obesity, diabetes, stroke, coronary heart disease - even death. Insomnia can also increase the risk of depression, anxiety and substance misuse. It is also a major problem for those suffering pain that lasts longer than three to six months and that is why we looked at this group.”
The most popular CBT strategies included education about good sleeping habits, such as a regular sleeping patterns and avoiding stimulus before going to bed.
Researchers found there was a mild to moderate decrease in pain immediately after therapy, as well as a decrease in depression. But CBT was not as effective when delivered electronically - either over the phone or via the Internet.
"We found little evidence that using therapies delivered either by phone or computer benefitted insomniacs. The jury is still out on the effectiveness of using automated sleep treatments. We found that, at the moment at least, delivering therapies personally had the most positive effect on sleeplessness," said Tang.
Several previous studies have found that getting a good night’s sleep helps reduce sensitivity to pain.
Researchers in Norway measured pain sensitivity in more than 10,000 adults and found a strong link between pain and insomnia. Patients with severe insomnia and chronic pain were twice as likely to pull their hands out of cold water early – a standard test to measure pain – than people who had neither condition.
A small 2012 study at Wayne State University found that people who had 10 hours of sleep a night had less sensitivity to pain in a heat test.