Therapy—not drugs—may be the best way to help people suffering from chronic pain finally get some much needed sleep. But only if the therapy is delivered in person.
A new study shows that people suffering from chronic pain who take part in cognitive behavior therapy not only benefit from improved sleep but also experience decreases in pain, fatigue, and depression.
“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,” says Nicole Tang, of the psychology department at the University of Warwick.
“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.
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. We believe that our results will be of particular interest to primary care physicians and allied health professionals who are taking up an increasingly important role in preventing and managing long-term conditions.”
For the study, researchers ran the first meta-analysis of the effects of non-drug treatments for sleeplessness, examining the experiences of more than 1,000 chronic pain sufferers.
They examined 72 studies of a total of 1,066 patients aged 45-61 who suffered from insomnia and experienced pain caused by a variety of ailments including long-term cancer, headaches, and arthritis.
Treatments evaluated covered a variety of approaches. Most popular intervention strategies included psycho-education about sleep hygiene (good sleeping habits such as a regular sleeping pattern), stimulus control, sleep restriction, and cognitive therapy.
In addition to highlighting the positive effect of cognitive behavior therapy on insomnia, researchers identified a mild to moderate decrease in pain immediately after therapy.
Improved sleep resulted in a decrease in depression following treatment and at follow-ups up to 12 months. The research team believes this highlights the value of treating insomnia which exists with chronic pain as early as possible.
When delivered electronically, however—either over the phone or via the internet—the therapies were found to be less effective.
“We found little evidence that using therapies delivered either by phone or computer benefited insomniacs,” Tang says. “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.”
Tang NK, Lereya T, Boulton H, Miller MA, Wolke D, Cappuccio FP
Nonpharmacological treatments of insomnia for long-term painful conditions: a systematic review and meta-analysis of patient-reported outcomes in randomized controlled trials
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