WITHIN Blog: November 2020
Can Catching Z’s Relieve Pain?
By Jenna Gillett and Dr Nicole Tang on behalf of the WITHIN Team.
02/11/2020
Recently, our Chief Investigator Dr Nicole Tang gave a talk at an online seminar hosted by the Royal Society of Medicine on the sleep-pain interaction. As part of her talk, Dr Tang outlined how sleep problems are often a frequent occurrence in many patients who have chronic pain. In this month’s blog we discuss some of the key highlights from Dr Tang’s talk and reflect on how sleep and pain are related.
Findings from multiple surveys have revealed that, if you talk to people attending hospital pain clinics, almost eight out of ten would tell you that they have problems sleeping. Despite this, sleep and pain are typically treated as two separate issues, and insomnia is rarely a priority in pain management.
“Chronic pain is exhausting and relentless. The pain doesn’t take breaks, it’s there day and night, 24/7. In the morning you battle to get out of bed due to exhaustion. In the afternoon you fight to stay awake because of fatigue and at night the pain continually keeps you awake tormenting you. My life’s now more about surviving than living.”
- B.L, A female patient on pain and comorbid insomnia, 2020
The role that sleep can have in shaping someone’s health is critical. Recent research has pointed to the fact that poor quality sleep and persistent short sleep duration are risk factors of a range of health conditions, including diabetes, obesity, coronary heart disease, cancer, psychiatric disorders and even dementia (Cappuccio, Miller, Lockley & Rajaratnam, 2018). There is also increasing evidence to suggest that insomnia is not a mere symptom of chronic pain. Rather, it is a major driver of chronic pain. Left untreated, it can amplify the spread and intensity of pain experience, worsen mood, reduce physical activity and make managing pain even more difficult than what it is already (Tang, 2018; Tang, Afolalu & Ramlee, 2018). It is now recognised that there are multiple benefits in prioritising treatment for pain-related insomnia, but these still very much focus on the sleep problems and the pain independently. A hybrid approach that addresses both pain and sleep problems at the same time may be a more efficient way to do this, and may be just what patients want to improve their quality of life.
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One potential method of targeting pain and comorbid insomnia is through hybrid cognitive behavioural therapy (CBT), which Dr Tang has researched. Hybrid therapeutic interventions which utilise techniques from both CBT for pain (CBT-P) and CBT for insomnia (CBT-I) have recently been shown to demonstrate positive results in improving pain and sleep outcomes in people who experience chronic pain and comorbid insomnia.
In two of our pilot studies in the UK (Tang, Goodchild, & Salkovskis, 2012; Tang et al., 2020), the hybrid CBT intervention was associated with greater improvement in sleep. Although pain intensity did not change, the group of patients who received the hybrid CBT reported greater reductions in pain interference, fatigue and depression than the group who just monitored their symptoms/were given self-help materials). What’s more, is that when the team spoke to individuals who completed the hybrid intervention, these individuals point to the positive effects of improved sleep on their mood, day-to-day pain management and other areas of their lives (Tang et al., 2020). Being able to improve sleep despite pain appeared to give these individuals the confidence to do more to improve their diet, exercise, weight management, stress management etc.
It is however worth noting that the development of hybrid CBT for pain and insomnia is still in its infancy. A definitive trial is to be done and there currently is not an infrastructure in our UK healthcare system to deliver the treatment. Our team is working hard to garner evidence of feasibility, efficacy and cost-effectiveness to one day make hybrid CBT for pain-related insomnia a concurrent part of pain management.
If you too are interested in our work, do consider signing up to our Warwick Sleep & Pain Lab Volunteers page – we are always looking for people to participate in our studies, and we send out a regular Newsletter to our subscribers to keep everyone up to date with our lab’s research activity.
Glossary:
Insomnia – a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep.
Hybrid Cognitive Behavioural Therapy (CBT) – a form of CBT that combines select components of CBT-I with interventions targeting the cognitive-behavioural processes maintaining chronic pain to target symptoms simultaneously.
Written by Jenna Gillett (Research Assistant, WITHIN Study) and Dr Nicole Tang (Chief Investigator, WITHIN Study & Director of the Warwick Sleep & Pain Lab). Based on “Insomnia and CBT in the pain clinic: Waking less to improve pain?” - a talk by Dr Nicole Tang for the Royal Society of Medicine: Sleep & Pain Webinar (Sep 2020)
References:
Cappuccio, F., Miller, M. A., Lockley, S. W., & Rajaratnam, S. M. (2018). Sleep, health and society–from aetiology to public health. Oxford University Press, Oxford.
Tang, N. K. (2018). Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 87, 281-289.
Tang, N. K., Afolalu, E. F., & Ramlee, F. (2018). Sleep and pain. In: Sleep health and society–from aetiology to public health. Oxford University Press, Oxford.
Tang, N. K., Goodchild, C. E., & Salkovskis, P. M. (2012). Hybrid cognitive-behaviour therapy for individuals with insomnia and chronic pain: a pilot randomised controlled trial. Behaviour research and therapy, 50(12), 814-821.
Tang, N. K., Moore, C., Parsons, H., Sandhu, H. K., Patel, S., Ellard, D. R., Nichols, V. P., Maden, J., Collard, V. E., Sharma, U. & Underwood, M. (2020). Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study. BMJ open, 10(3), e034764.