Assessing Beliefs and Treating Insomnia and Chronic Pain

The Pain-Related Beliefs and Attitudes about Sleep (PBAS) scale offers a tool to assess the interaction between sleep, insomnia and chronic pain.
The Pain-Related Beliefs and Attitudes about Sleep (PBAS) scale offers a tool to assess the interaction between sleep, insomnia and chronic pain.

There is increasing evidence that individual beliefs, attitudes, and thoughts can initiate and perpetuate insomnia, and influence the duration and severity of chronic pain.

A study published in the Clinical Journal of Pain found that, while there are similarities in the pattern and severity of sleep disturbance between primary insomnia (insomnia in the absence of chronic pain) and pain-related insomnia, thought processes appear to play a significant role in the manifestation of pain-related insomnia.1

In a subsequent article, researchers showed that among patients with chronic pain, thoughts that are focused on pain before sleep were significantly associated with poorer sleep continuity.2

The precise prevalence of insomnia, however, depends on the specific case definition and the tool used for its assessment. Consequently, prevalence estimates have varied widely, ranging from 10% to 40% of the general population,3 with higher prevalence reported in individuals with chronic pain, including fibromyalgia, lower back pain and arthritis.4-6

Insomnia associated with chronic pain is thought to worsen the pain sensation and diminish coping ability. In addition, dysfunctional beliefs, attitude, and thoughts can all influence the pain sensation and impact sleep quality and insomnia.7

According to Nicole Tang, DPhil, C Psychol, Associate Professor in the Department of Psychology at Warwick University, UK, “Thoughts can have a direct and/or indirect impact on our emotion, behavior and even physiology. The way [we] think about sleep and its interaction with pain can influence the way 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.”

Sleep-related “dysfunctional beliefs”, persistent anxiety and worry have been shown to be critical in mediating the perpetuation or exacerbation of insomnia.8

This association between cognition and insomnia suggests that insomnia can be manipulated by cognitive behavioral therapy (CBT), and that addressing dysfunctional beliefs when treating patients with comorbid insomnia and chronic pain might represent a promising approach.9

While the role of cognitive factors in the etiology of insomnia is well-recognized, few validated tools are available to evaluate patient-specific, sleep-related aspects of cognition relevant for therapy. To address this gap, the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale consisting of 30 items was developed as a research and clinical tool to evaluate sleep-disruptive cognitive behaviors.10

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