Many patients with chronic neck and back pain find it nearly impossible to get a good, restful night of sleep. In fact, it is estimated that 65% of people with a chronic pain condition experience sleep problems. While some turn to prescription or over-the-counter sleep aids, there is the risk of drug interaction and other side effects if the patient is also taking pain medication. A new study at the University of Rochester shows that cognitive behavioral therapy can significantly improve sleep and daily functioning in patients suffering from chronic neck or back pain.
The study, published online in February 2010 by the journal Sleep Medicine, was funded by the National Institute of Nursing Research. The therapy ran for eight weeks and was conducted by a trained nurse therapist. Sessions included sleep restriction, stimulus control, sleep hygiene, and a discussion of catastrophic thoughts about the consequences of insomnia. Twenty-eight patients participated, and their progress was tracked through detailed sleep diaries.
Researchers noted common behaviors in chronic pain patients that likely contribute to the high incidence of insomnia: sleeping when not tired, sleeping in places other than the bedroom, and engaging in non-sleep behaviors—such as watching television in bed—can all significantly affect the quality of sleep received at night. Therapists addressed these unhealthy sleep behaviors and helped patients establish a structure for the specific time they spent in bed.
After the eight weeks, participants reported a significant improvement in the quality of sleep and also a reduction in the extent to which pain interfered in daily activities. Specifically:
- Subjects receiving cognitive behavioral therapy (CBT-I) experienced improvements in:
- sleep latency (time to fall asleep)
- waking after sleep onset
- number of awakenings
- sleep efficiency
- Significant reductions in Insomnia Severity (ISI) (p = 0.05) were found in the CBT-I group
- Behavioral therapy recipients also experienced significant reductions (p = 0.03) in pain interference with daily life, as measured by the Interference Scale of the Multidimensional Pain Inventory
- On mood measures or measures of pain severity, the groups did not differ significantly
Non-medication options such as behavioral therapy may be particularly attractive to back pain sufferers who also suffer sleep problems, since many already take several medications and are reluctant to add another to the list. Other psychological techniques like behavioral therapy used to help with sleep problems include relaxation training, meditation, and hypnosis. Good sleep habits are also recommended for improving sleep quality but can be more challenging for people with chronic pain issues who may try to utilize sleep throughout the day as a brief escape from the pain.