STUDY: Thoughts about Sleep May Cause Insomnia and Worsen Pain

People with chronic pain who believe they won’t be able to sleep are more likely to suffer from insomnia, thus causing worse pain, says a study from the University of Warwick published in the Journal of Clinical Sleep Medicine.

Esther Afolalu and colleagues from the Sleep and Pain Lab in the Department of Psychology created a scale to measure beliefs about sleep and pain in chronic pain patients, alongside their quality of sleep.  According to the researchers, this is the first scale to combine both pain and sleep and explore the cycle between sleep and pain problems.

They say that conditions like back pain, fibromyalgia, and arthritis are linked with negative thoughts about insomnia and pain, and this may be managed by cognitive-behavioral therapy (CBT).

The study evaluated the psychometric and functional properties of a 10-item Pain-Related Beliefs and Attitudes about Sleep (PBAS) scale.  The PBAS scale was administered to four clinical samples of chronic pain patients who also had insomnia.  One examined the scale’s psychometric properties (n=137), one examined the test-retest reliability (n=26, one examined the sensitivity to treatment (n=20) and the fourth examined generalizability (n=62).  All study participants completed the PBAS with validated measures of pain interference, insomnia severity, and cognitive-behavioral processes hypothesized to underpin insomnia.

The results of their study show that people who believe they won’t be able to sleep as a result of their pain are more likely to suffer from insomnia, which results in more pain.  The scale they developed enabled researchers to predict patients’ level of insomnia and pain.  

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 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. This scale provides a useful clinical tool to assess and monitor treatment progress during these therapies,” Esther Afolalu explained.

Dr. Nicole Tang, the study senior author, said, “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. 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.”

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