Combining Cognitive Behavioral Therapy for Insomnia and Chronic Spinal Pain Within Physical Therapy: A Practical Guide for the Implementation of an Integrated Approach

Abstract Most people who have nonspecific chronic spinal pain (nCSP) report comorbid insomnia. However, in current treatment strategies for nCSP, insomnia is usually not addressed. Considering the bidirectional interaction between pain and sleep and its underlying psychophysiological mechanisms, ins...

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Bibliographic Details
Published in:Physical therapy 2022-08, Vol.102 (8)
Main Authors: Van Looveren, Eveline, Meeus, Mira, Cagnie, Barbara, Ickmans, Kelly, Bilterys, Thomas, Malfliet, Anneleen, Goubert, Dorien, Nijs, Jo, Danneels, Lieven, Moens, Maarten, Mairesse, Oliver
Format: Article
Language:English
Subjects:
Behavior modification
chronic pain
Chronic Spinal Pain
Clinical Medicine
Cognitive Behavioral Therapy
Cognitive therapy
Comorbidity
human
Humans
Insomnia
Klinisk medicin
Pain
Physical therapy
Physical Therapy Modalities
physiotherapy
Sleep
Sleep Initiation and Maintenance Disorders
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Summary:Abstract Most people who have nonspecific chronic spinal pain (nCSP) report comorbid insomnia. However, in current treatment strategies for nCSP, insomnia is usually not addressed. Considering the bidirectional interaction between pain and sleep and its underlying psychophysiological mechanisms, insomnia may increase the risk of developing adverse physical and psychological health outcomes and should thus no longer be left untreated. As suggested by previous pilot studies, adding cognitive behavioral therapy for insomnia to the contemporary evidence-based biopsychosocial physical therapy approach may also improve pain outcomes in nCSP. This manuscript aims to provide practical guidelines on hybrid physical therapy, including the combination of the following components: (1) pain neuroscience education (eg, to reconceptualize pain) and cognition-targeted exercise therapy (eg, graded exposure to functional daily life movements), and (2) cognitive behavioral therapy for insomnia (sleep psychoeducation, behavioral and cognitive therapy, correction of sleep hygiene, and relaxation therapy) can be deployed for the management of patients who have chronic spinal pain. Impact. Due to the major impact sleep disturbances have on pain and disability, insomnia as a comorbidity should no longer be ignored when treating patients with chronic spinal pain.
ISSN:0031-9023
1538-6724
1538-6724
DOI:10.1093/ptj/pzac075