Do People With Chronic Pain Judge Their Sleep Differently? A Qualitative Study

Ramlee, Fatanah; Afolalu, Esther F.; Tang, Nicole K. Y.

doi:10.1080/15402002.2016.1188393

Cited by 11 publications

(10 citation statements)

References 56 publications

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“…The development of hybrid treatments for chronic pain and insomnia is only in its infancy, but it is certainly a movement gaining momentum at a time when the term 'secondary insomnia' is being phased out (94) and epidemiological evidence is accumulating to show that sleep is a risk factor and a potential cause of a range of physical and mental illnesses, directly and indirectly increasing the risk of mortality (95). The momentum is also bolstered by demands from the pain patients themselves, explicitly stating the negative impact on pain management when they are not sleeping well (96,97) and indicating that their wish to receive more support and help in obtaining better sleep (9,98,99).…”

Section: Recent Development In Pain and Insomnia As An Examplementioning

confidence: 99%

Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future

Tang

2018

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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Cognitive Behavioural Therapy (CBT) is a form of evidence-based talking therapy that emphasises the importance of behaviour and conscious thoughts in shaping our emotional experiences. As pain becomes increasingly accepted as not only a sensory but also an emotional experience, success in using CBT to treat emotional disorders has resulted in the incorporation of cognitive-behavioural principles into the management of chronic pain. Outcomes of CBT-informed interdisciplinary pain management programmes are modest at best, despite rapid methodological improvements in trial design and implementation. Whilst the field searches for new treatment directions, a hybrid CBT approach that seeks to simultaneously tackle pain and its comorbidities shows promise in optimising treatment effectiveness and flexibility. This article provides a brief description of the core characteristics of CBT and the transformation this therapeutic model has brought to our understanding and management of chronic pain. Current evidence on efficacy of CBT for chronic pain is then reviewed, followed by a critical consideration of the advantages and disadvantages of the new hybrid treatment approach that conceptualises and treats chronic pain in connection with its comorbidities. Recent progress made in the area of pain and insomnia is highlighted as an example to project therapeutic innovations in the near future.

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Section: Recent Development In Pain and Insomnia As An Examplementioning

confidence: 99%

Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future

Tang

2018

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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“…Sleep and mood are therefore central components both in expression of illness, and as part of the multimodality treatment of chronic pain patients. There is emerging evidence that chronic pain patients with comorbid sleep problems are aware of the bidirectional relationship between the constructs (Tang et al, 2009; Ramlee et al, 2016). Hence, there is great potential in assessing and utilizing attributions to aid accurate understanding and treatment of chronic pain and its comorbid conditions.…”

Section: Introductionmentioning

confidence: 99%

How Perceived Pain Influence Sleep and Mood More Than The Reverse: A Novel, Exploratory Study with Patients Awaiting Total Hip Arthroplasty

Blågestad¹,

Pallesen²,

Grønli³

et al. 2016

Front. Psychol.

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Objectives: Attributions about how comorbid symptoms worsen or improve each other are central cognitive components of chronic pain that are shown to facilitate or impede the recovery process. Still, these attributions have been poorly illuminated in chronic pain patients. The present study explored perceptions of how sleep, pain, and mood influence each other in patients awaiting total hip arthroplasty (THA).Design and Methods: In this cross-sectional study, 291 patients (mean age 67.8, 65.3% female) rated 12 statements about how much a given symptom (pain, sleep, mood) changed when another symptom (pain, sleep, mood) worsened or improved on a response scale ranging from much worse (-2) via no change (0) to much better (2). Sleep (Bergen Insomnia Scale), pain (McGill Pain Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale) were assessed as background variables.Results: Of the patients in the study, 56% reported symptoms indicating insomnia. Anxiety and depression were indicated in 16 and 10%, respectively. Over 80% rated their pain as horrible/unbearable and reported that pain occurred always/daily. When experiencing increased pain, a majority perceived that sleep (90%) and mood (70%) worsened, whilst experiencing reduced pain improved sleep and mood in 50%. Poor sleep increased pain and worsened mood in 45 and 60% of the patients, respectively. Better sleep was perceived to reduce pain and improve mood in 50%. Worsened mood increased pain (46%) and worsened sleep (52%). Improved mood decreased pain and improved sleep in 25 and 35%, respectively.Discussion: In this study, a novel approach was used to investigate perceptions of reciprocal relationships between symptoms. We found that THA patients perceived interrelationships between pain, sleep and mood. These perceived interrelations were stronger when symptoms worsened than when symptoms improved. They also held stronger beliefs about the effect of pain on sleep and mood, than the effect of sleep and mood on pain. Attributions are central in illness perception and ultimately affect illness behavior. For patients who perceive symptoms to interrelate, the door has already been opened to utilize these attributions in treatments aiming to disrupt vicious cycles, hence supporting the use of multimodal treatments.

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“… 16 , 18 , 21 , 26 , 27 , 36–38 The selection of parameters was also informed by themes that emerged from a recent qualitative study conducted by our group, in which we explored the criteria people use to judge their sleep quality. 28 In this study, we found that people by and large rely on their (1) memories of nighttime sleep disruptions, (2) feelings on waking and cognitive functioning during the day, (3) ability to engage in daytime physical and social activity, and (4) changes in physical symptoms as key criteria for evaluating their sleep quality. Accordingly, the chosen parameters were not restricted to the sleep period, but included factors that spanned from the day before the sleep period to the day after.…”

Section: Methodsmentioning

confidence: 82%

“…For example, in our research with people with chronic pain and comorbid insomnia, we found that patients considered pain and discomfort in the morning and how much they can physically do during the day as the most important indicators of sleep quality of the night before. 28 …”

Section: Introductionmentioning

confidence: 99%

What sways people’s judgement of sleep quality? A quantitative choice-making study with good and poor sleepers

Ramlee

Sanborn

Tang

2017

Sleep

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Study objectives:We conceptualized sleep quality judgment as a decision-making process and examined the relative importance of 17 parameters of sleep quality using a choice-based conjoint analysis.Methods:One hundred participants (50 good sleepers; 50 poor sleepers) were asked to choose between 2 written scenarios to answer 1 of 2 questions: “Which describes a better (or worse) night of sleep?”. Each scenario described a self-reported experience of sleep, stringing together 17 possible determinants of sleep quality that occur at different times of the day (day before, pre-sleep, during sleep, upon waking, day after). Each participant answered 48 questions. Logistic regression models were fit to their choice data.Results:Eleven of the 17 sleep quality parameters had a significant impact on the participants’ choices. The top 3 determinants of sleep quality were: Total sleep time, feeling refreshed (upon waking), and mood (day after). Sleep quality judgments were most influenced by factors that occur during sleep, followed by feelings and activities upon waking and the day after. There was a significant interaction between wake after sleep onset and feeling refreshed (upon waking) and between feeling refreshed (upon waking) and question type (better or worse night of sleep). Type of sleeper (good vs poor sleepers) did not significantly influence the judgments.Conclusions:Sleep quality judgments appear to be determined by not only what happened during sleep, but also what happened after the sleep period. Interventions that improve mood and functioning during the day may inadvertently also improve people’s self-reported evaluation of sleep quality.

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Do People With Chronic Pain Judge Their Sleep Differently? A Qualitative Study

Abstract: 39People with chronic pain often report sleep of "poor quality".

Cited by 11 publications

References 56 publications

Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future

Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future

How Perceived Pain Influence Sleep and Mood More Than The Reverse: A Novel, Exploratory Study with Patients Awaiting Total Hip Arthroplasty

What sways people’s judgement of sleep quality? A quantitative choice-making study with good and poor sleepers

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