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Phys Ther. 2018 May 1;98(5):325-335. doi: 10.1093/ptj/pzy020.

Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice.

Author information

1
Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, the Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium, and Vrije Universiteit Brussel, Building F-Kima, Laarbeeklaan 103, BE-1090 Brussels, Belgium.
2
Brugmann University Hospital, Sleep Laboratory and Unit for Chronobiology U78, Université Libre de Bruxelles - Vrije Universiteit Brussel, Brussels, Belgium, and the Department of Experimental and Applied Psychology (EXTO), Vrije Universiteit Brussel.
3
Brugmann University Hospital, Sleep Laboratory and Unit for Chronobiology U78, Université Libre de Bruxelles - Vrije Universiteit Brussel, and UNI Neuroscience Institute, ULB312 Faculty of Medicine, and ULB388 Faculty of Motor Sciences, Université Libre de Bruxelles.
4
Pain in Motion International Research Group, and the Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel.
5
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Ghent University, Ghent, Belgium.
6
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Ghent University.
7
Pain in Motion International Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Ghent University.
8
Department of Neurosurgery and Radiology, University Hospital, and the Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel.
9
Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, and the Department of Physical Medicine and Physiotherapy, University Hospital Brussels.
10
Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, and Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Ghent University.

Abstract

Among people with chronic pain, insomnia is highly prevalent, closely related to the mechanism of central sensitization, characterized by low-grade neuroinflammation, and commonly associated with stress or anxiety; in addition, it often does not respond effectively to drug treatments. This review article applies the current understanding of insomnia to clinical practice, including assessment and conservative treatment of insomnia in people with chronic pain. Cognitive-behavioral therapy for insomnia can be efficacious for improvements in sleep initiation, sleep maintenance, perceived sleep quality, and pain interference with daily functioning in people with chronic pain. A recent systematic review concluded that with additional training, physical therapist-led cognitive-behavioral interventions are efficacious for low back pain, allowing their implementation within the field. Cognitive-behavioral therapy for insomnia, as provided to people with chronic pain, typically includes education, sleep restriction measures, stimulus control instructions, sleep hygiene, and cognitive therapy.

PMID:
29425327
DOI:
10.1093/ptj/pzy020

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