Health Anxiety, Pain and Insomnia (HAPI) Research Group

Insomnia (in chronic pain)

Health Anxiety Pain & Insomnia Research Group

Key research interests

  • Cognitive-behavioural processes in insomnia
  • Cognitive behaviour therapy for primary insomnia
  • Use of behavioural experiment in treatment
  • Sleep-pain relationship

Background

Sleep plays a vital role in maintaining our mental and physical health. Naturally, not being able to sleep well could be a major source of distress. Indeed insomnia is amongst the most prevalent psychological health complaints, with at least 1 in every 10 adults suffering from insomnia chronically1-2. Untreated insomnia could have serious health consequences, not only in terms of day-to-day functioning (e.g., impaired concentration, memory and mood) 3 but also in terms of increasing the risk of developing a psychological/medical problem in the long run (e.g., depression, anxiety, substance dependency) 4. In a recent study by our group5 we note that above 50% of the patients seeking treatment at a pain management centre meet criteria for clinical insomnia. Based on this finding, our group now are starting a programme of research identifying the factors driving sleep disturbance in chronic pain and investigating the relationship between sleep and pain.

Funder: Croucher Foundation Hong Kong (www.croucher.org.hk)

Thinking about thinking about pain: A qualitative study investigating rumination in chronic pain

Pain intensity and disability in chronic pain have recently been linked to pain-related rumination. However, while rumination is commonly observed in chronic pain patients, the nature of rumination in chronic pain is poorly defined and the mechanisms through which rumination may act to increase pain and disability remain unspecified. Semi-structured interviews were conducted with 20 chronic pain patients in order to establish the phenomenology of rumination in chronic pain and generate testable hypotheses for empirical investigation. Extracted themes included: rumination is triggered by pain and negative emotion (and vice versa), positive beliefs about rumination, negative beliefs about the self, rumination precedes and affects sleep. A number of interesting differences were found between a minority of participants who were identified as infrequent ruminators and the rest of the sample.

Status: This paper is currently under review by the European Journal of Pain

Recently completed projects

Prevalence and correlates of clinical insomnia co-occurring with chronic back pain

Given the suggestion of a reciprocal relationship between sleep and pain and the recognition of sleep as an important parameter in determining quality of life, there is increasing interest in sleep disturbance linked to chronic pain. The present study aimed to provide an estimate of the prevalence of 'clinical insomnia' in patients attending a specialist pain clinic and identify factors associated with it. Seventy chronic back pain patients and 70 gender- and age-matched pain-free controls completed a set of questionnaires measuring sleep, pain and a selection of general and specific psychological variables. Scores suggestive of clinical insomnia were noted in 53% of chronic pain patients as compared to only 3% in pain-free controls. Among the pain and psychological variables examined, the tendency to interpret pain in affective terms and the level of health anxiety were the best predictors of insomnia severity, even when pain intensity was controlled for.

Status: This paper has now been published in the Journal of Sleep Research.

References

  1. National Institutes of Health State of Science Conference Statement. (2005). Manifestations and management of chronic insomnia in adults. Sleep, 28, 1049-1057.
  2. Simon, G.E., & Von Korff, M. (1997). Prevalence, burden and treatment of insomnia in primary care. American Journal of Psychiatry, 154, 1417-1423.
  3. Roth, T., & Ancoli-Israel, S. (1999). Daytime consequences and correlates of insomnia in the United States: Results of the 1991 National Sleep Foundation Survey II. Sleep, 22, S354-358.
  4. Ford, D. E., & Kamerow, D. B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders: An opportunity for prevention? Journal of American Medical Association, 262, 1479-1484.
  5. Tang, N.K.Y., Wright, K., Salkovskis, P. (2006). Prevalence and correlates of insomnia co-occurring in chronic back pain. Manuscript submitted for publication.