To ease chronic pain, direct thoughts elsewhere
JOHNS HOPKINS (US) — Chronic pain sufferers may sleep better and experience less day-to-day discomfort by learning to dwell less on their ailments, say researchers.
Sleeping pills and painkillers can help, but at least some patients may benefit just as much, if not more, from cognitive behavioral therapy to help them reduce their mental focus on physical pain, researchers say.
“We have found that people who ruminate about their pain and have more negative thoughts about their pain don’t sleep as well, and the result is they feel more pain,” says Luis F. Buenaver, leader of a study published online in the journal Pain.
The study highlights the function of a major neurological pathway that links negative thinking about pain to disturbed sleep that leads to increased pain, Buenaver says.
“If cognitive behavioral therapy can help people change the way they think about their pain,” he says, “they might end that vicious cycle and feel better, without sleeping pills or pain medicine.”
Buenaver, assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, says that roughly 80 percent of people with chronic pain experience sleep disturbances.
Previous studies have shown that people whose sleep patterns are altered are more sensitive to pain. It is also known, he says, that those who focus frequently on their pain and think more negatively about their pain report more debilitating pain. Such “pain catastrophizing,” he adds, has been found to be a better predictor of worse pain and pain-related disability than depression, anxiety, or neuroticism.
For this study, Buenaver and his colleagues recruited 214 people with myofascial temporomandibular disorder, or TMD, serious facial and jaw pain believed to be stress-related in many cases. The participants were mostly white and female, with an average age of 34. Each underwent a dental exam to confirm TMD, then filled out questionnaires assessing sleep quality, depression, pain levels, and emotional responses to pain, including whether they ruminate on it or exaggerate it.
Researchers found a direct correlation in the TMD patients between negative thinking about pain and poor sleep, as well as with worse pain.
Buenaver and his colleagues are now studying whether older adults with arthritis and insomnia can benefit from cognitive behavioral therapy for insomnia.
He says that CBT—a form of counseling that focuses on changing thinking to influence behavior—may also help people who suffer from stress-related ailments without a clear underlying pathology other than TMD. Examples include fibromyalgia, irritable bowel syndrome, and some headaches and neck and back pain.
“It may sound simple, but you can change the way you feel by changing the way you think,” Buenaver said.
The research was supported by grants from the National Institutes of Health.
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