Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions

Insomnia is a major source of distress to people with chronic pain; many of whom presenting for treatment want tangible help with sleep.Compared to chronic pain patients who do not have trouble sleeping, those who do, report more severe pain, longer pain duration, greater levels of anxiety, depression and health anxiety, and worse impairment in physical and psychosocial functioning.Sleep disturbance experienced by patients with chronic pain can be characterised by longer sleep onset, more frequent and longer awakenings after sleep onset, shorter total sleep time, lower sleep efficiency and poorer sleep quality. Such pattern of disturbance is analogous to that of primary insomnia.The relationship between pain and sleep is likely to be bi-directional, although exactly how the two problems interact is little understood.The offer of sleep advice and the use of pharmacotherapy for pain-related insomnia have their respective limitations. Psychological and behavioural treatments demonstrated to be effective for both primary and comorbid insomnia may be a viable treatment alternative.