Combining Cognitive Behavioral Therapy for Insomnia and Chronic Spinal Pain Within Physical Therapy: A Practical Guide for the Implementation of an Integrated Approach

Author:

Van Looveren Eveline12,Meeus Mira234,Cagnie Barbara2,Ickmans Kelly567,Bilterys Thomas52,Malfliet Anneleen567,Goubert Dorien2,Nijs Jo568,Danneels Lieven2,Moens Maarten910,Mairesse Oliver1112

Affiliation:

1. Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy , Vrije Universiteit Brussel, Brussels , Belgium

2. Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University , Ghent , Belgium

3. Department of Rehabilitation Sciences and Physiotherapy (REVAKI) , Faculty of Medicine and Health Sciences, , Antwerp , Belgium

4. University of Antwerp , Faculty of Medicine and Health Sciences, , Antwerp , Belgium

5. Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel , Brussels , Belgium

6. Department of Physical Medicine and Physiotherapy, University Hospital Brussels , Brussels , Belgium

7. Research Foundation – Flanders (FWO) , Brussels , Belgium

8. Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden

9. Department of Neurosurgery and Radiology, University Hospital Brussels , Brussels , Belgium

10. Center of Neurosciences (C4N), Vrije Universiteit Brussel , Brussels , Belgium

11. Department of Psychology - Brain, Body and Cognition (BBCO) , Vrije Universiteit Brussel, Brussels , Belgium

12. Brugmann University Hospital, Sleep Laboratory and Unit for Clinical Chronobiology , Brussels , Belgium

Abstract

Abstract Most people who have nonspecific chronic spinal pain (nCSP) report comorbid insomnia. However, in current treatment strategies for nCSP, insomnia is usually not addressed. Considering the bidirectional interaction between pain and sleep and its underlying psychophysiological mechanisms, insomnia may increase the risk of developing adverse physical and psychological health outcomes and should thus no longer be left untreated. As suggested by previous pilot studies, adding cognitive behavioral therapy for insomnia to the contemporary evidence-based biopsychosocial physical therapy approach may also improve pain outcomes in nCSP. This manuscript aims to provide practical guidelines on hybrid physical therapy, including the combination of the following components: (1) pain neuroscience education (eg, to reconceptualize pain) and cognition-targeted exercise therapy (eg, graded exposure to functional daily life movements), and (2) cognitive behavioral therapy for insomnia (sleep psychoeducation, behavioral and cognitive therapy, correction of sleep hygiene, and relaxation therapy) can be deployed for the management of patients who have chronic spinal pain. Impact. Due to the major impact sleep disturbances have on pain and disability, insomnia as a comorbidity should no longer be ignored when treating patients with chronic spinal pain.

Funder

Applied Biomedical Research Program, Research Foundation Flanders

Publisher

Oxford University Press (OUP)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

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