Negative thoughts about sleep may worsen chronic pain: study

Having negative thoughts about insomnia and pain can worsen conditions like back pain and arthritis, scientists have found, suggesting that chronic pain can be managed using cognitive therapy.
People with chronic pain who believe they would not be able to sleep are more likely to suffer from insomnia, thus causing worse pain.
The study could lead to specific cognitive therapy to cure insomnia and treat chronic pain.
It shows that the way chronic pain patients think about pain and sleep leads to insomnia and poor management of pain.
Esther Afolalu and colleagues from the University of Warwick in the UK have formulated a pioneering scale to measure beliefs about sleep and pain in long-term pain patients, alongside their quality of sleep - the first of its type to combine both pain and sleep and explore the vicious cycle between sleep and pain problems.

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 would not 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 cognitive-behavioural therapy (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.

"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," said Afolalu.
"This scale provides a useful clinical tool to assess and monitor treatment progress during these therapies," she said.
"Thoughts can have a direct and/or indirect impact on our emotion, behaviour 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 Nicole Tang, the study senior author.

"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 was published in the Journal of Clinical Sleep Medicine.