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Abstract
Sleep disturbance is perhaps one of the most prevalent complaints of patients with
chronically painful conditions. Experimental studies of healthy subjects and cross-sectional
research in clinical populations suggest the possibility that the relationship between
sleep disturbance and pain might be reciprocal, such that pain disturbs sleep continuity/quality
and poor sleep further exacerbates pain. This suggests that aggressive management
of sleep disturbance may be an important treatment objective with possible benefits
beyond the improvement in sleep. Little is known, however, about how to effectively
treat sleep disturbance associated with pain or whether such treatment might have
beneficial effects on reducing pain. A small, but growing literature has applied cognitive-behavioral
therapies (CBT) for either pain management or insomnia to patients with chronic pain.
In this article, we review the longitudinal literature on sleep disturbance associated
with chronic pain and clinical trial literatures of cognitive-behavior therapy for
pain management and insomnia secondary to chronic pain with the aim of evaluating
whether the relationship between clinical pain and insomnia is reciprocal. While methodological
problems are common, the literature suggests that the relationship is reciprocal and
CBT treatments for pain or insomnia hold promise in reducing pain severity and improving
sleep quality. Directions for future research include the use of validated measures
of sleep, longitudinal studies, and larger randomized clinical trials incorporating
appropriate attentional controls and longer periods of follow-up.