Smith Michael T, Haythornthwaite Jennifer A
Department of Psychiatry and Behavioral Sciences, Behavioral Medicine Research Laboratory, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 218, Baltimore, MD 21287-7218, USA.
Sleep Med Rev. 2004 Apr;8(2):119-32. doi: 10.1016/S1087-0792(03)00044-3.
Sleep disturbance is perhaps one of the most prevalent complaints of patients with chronically painful conditions. Experimental studies of healthy subjects and cross-sectional research in clinical populations suggest the possibility that the relationship between sleep disturbance and pain might be reciprocal, such that pain disturbs sleep continuity/quality and poor sleep further exacerbates pain. This suggests that aggressive management of sleep disturbance may be an important treatment objective with possible benefits beyond the improvement in sleep. Little is known, however, about how to effectively treat sleep disturbance associated with pain or whether such treatment might have beneficial effects on reducing pain. A small, but growing literature has applied cognitive-behavioral therapies (CBT) for either pain management or insomnia to patients with chronic pain. In this article, we review the longitudinal literature on sleep disturbance associated with chronic pain and clinical trial literatures of cognitive-behavior therapy for pain management and insomnia secondary to chronic pain with the aim of evaluating whether the relationship between clinical pain and insomnia is reciprocal. While methodological problems are common, the literature suggests that the relationship is reciprocal and CBT treatments for pain or insomnia hold promise in reducing pain severity and improving sleep quality. Directions for future research include the use of validated measures of sleep, longitudinal studies, and larger randomized clinical trials incorporating appropriate attentional controls and longer periods of follow-up.
睡眠障碍可能是慢性疼痛患者最普遍的主诉之一。对健康受试者的实验研究以及临床人群的横断面研究表明，睡眠障碍与疼痛之间的关系可能是相互的，即疼痛会干扰睡眠连续性/质量，而睡眠不佳会进一步加重疼痛。这表明积极治疗睡眠障碍可能是一个重要的治疗目标，其益处可能不止于改善睡眠。然而，对于如何有效治疗与疼痛相关的睡眠障碍，或者这种治疗是否可能对减轻疼痛有有益效果，人们知之甚少。一小部分但数量在不断增加的文献将认知行为疗法（CBT）应用于慢性疼痛患者的疼痛管理或失眠治疗。在本文中，我们回顾了关于与慢性疼痛相关的睡眠障碍的纵向文献，以及针对慢性疼痛继发的疼痛管理和失眠的认知行为疗法的临床试验文献，目的是评估临床疼痛与失眠之间的关系是否是相互的。虽然方法学问题很常见，但文献表明这种关系是相互的，针对疼痛或失眠的CBT治疗有望减轻疼痛严重程度并改善睡眠质量。未来研究的方向包括使用经过验证的睡眠测量方法、纵向研究，以及纳入适当注意力控制和更长随访期的更大规模随机临床试验。
