Change in attitude may ease chronic pain by aiding sleep, study suggests

"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, Ph.D., an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the leader of a study published online in the journal Pain. "If cognitive behavioral therapy can help people change the way they think about their pain, they might end that vicious cycle and feel better without sleeping pills or pain medicine."

Buenaver and his colleagues say the study highlights the function of a major neurological pathway linking negative thinking about pain to increased pain through disturbed sleep. Buenaver says roughly 80 percent of people with chronic pain experience sleep disturbances, and 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 more robust predictor of worse pain and pain-related disability than depression, anxiety or neuroticism.

For the study, researchers 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 years. Each participant 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 or exaggerate it.

Researchers found a direct correlation between negative thinking about pain and poor sleep, as well as with worse pain in the TMD patients.

Buenaver says sleeping pills and painkillers can help, but these pain patients may benefit just as much, if not more, from cognitive behavioral therapy. He says the same may be true of people who suffer from other stress-related ailments without a clear underlying pathology, including fibromyalgia, irritable bowel syndrome and some headaches, neck and back pain.

"It may sound simple, but you can change the way you feel by changing the way you think," Buenaver said.

He and his colleagues currently are studying whether older adults with arthritis and insomnia can benefit from cognitive behavioral therapy for insomnia.

The research is supported by grants from the National Institutes of Health.

Other Hopkins researchers contributing to the study include Mpepera Simango; Jennifer A. Haythornthwaite, Ph.D.; and Michael T. Smith, Ph.D.