Integrative Sleep Medicine and Chronic Pain Management

2021 ◽  
pp. 433-448
Author(s):  
Ashwin Mehta
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbances ◽  
Tai Chi ◽  
Behavioral Therapy ◽  
Treatment Strategies ◽  
Chronic Pain Management ◽  
Comprehensive Management ◽  
Physical Discomfort ◽  
Nonrestorative Sleep ◽  
Bidirectional Relationship

Widespread opioid dependency has spurred growing interest in nonpharmacologic methods of addressing chronic pain. Timely research has established a reciprocal and bidirectional relationship between physical discomfort and sleep disturbances. Thus, comprehensive management of chronic pain necessitates a thorough sleep evaluation because underlying sleep concerns can often thwart otherwise effective treatment strategies. Interventions such as cognitive-behavioral therapy are useful to loosen the psychologic association patients commonly form between chronic pain and nonrestorative sleep. Exercise and mindfulness are among those modalities with the best evidence to simultaneously address both sleep loss and chronic pain. Acupuncture, yoga, and tai chi, as well as certain herbs, can be used to stem the inflammatory cascade that frequently hinders successful treatment. Integrative approaches that promote restful sleep are of increasing importance in the context of managing chronic pain.

scholarly journals Analysis of State Insurance Coverage for Nonpharmacologic Treatment of Low Back Pain as Recommended by the American College of Physicians Guidelines

2019 ◽  
Vol 8 ◽  
pp. 216495611985562 ◽  
Author(s):  
Robert Bonakdar ◽  
Dania Palanker ◽  
Megan M Sweeney
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Spinal Manipulation ◽  
Tai Chi ◽  
Insurance Coverage ◽  
Low Back ◽  
Chronic Pain Management ◽  
Multidisciplinary Rehabilitation ◽  
Nonpharmacologic Treatment

Background In 2017, the American College of Physicians (ACP) released guidelines encouraging nonpharmacologic treatment of chronic low back pain (LBP). These guidelines recommended utilization of treatments including multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (MBSR), tai chi, yoga, progressive relaxation, biofeedback, cognitive behavioral therapy (CBT), and spinal manipulation. Objective We aimed to determine status of insurance coverage status for multiple nonpharmacological pain therapies based on the 2017 Essential Health Benefits (EHB) benchmark plans across all states. Methods The 2017 EHB benchmark plans represent the minimum benefits required in all new policies in the individual and small group health insurance markets and were reviewed for coverage of treatments for LBP recommended by the ACP guidelines. Additionally, plans were reviewed for limitations and exclusionary criteria. Results In nearly all state-based coverage policies, chronic pain management and multidisciplinary rehabilitation were not addressed. Coverage was most extensive (supported by 46 states) for spinal manipulation. Acupuncture, massage, and biofeedback were each covered by fewer than 10 states, while MBSR, tai chi, and yoga were not covered by any states. Behavioral health treatment (CBT and biofeedback) coverage was often covered solely for mental health diagnoses, although excluded for treating LBP. Conclusion Other than spinal manipulation, evidence-based, nonpharmacological therapies recommended by the 2017 ACP guidelines were routinely excluded from EHB benchmark plans. Insurance coverage discourages multidisciplinary rehabilitation for chronic pain management by providing ambiguous guidelines, restricting ongoing treatments, and excluding behavioral or complementary therapy despite a cohesive evidence base. Better EHB plan coverage of nondrug therapies may be a strategy to mitigate the opioid crisis. Recommendations that reflect current research-based findings are provided to update chronic pain policy statements.

Complementary and Integrative Health Interventions for Insomnia in Veterans and Military Populations

2021 ◽  
pp. 003329412110484
Author(s):  
Julie K. Staples ◽  
Courtney Gibson ◽  
Madeline Uddo
Keyword(s):  
Sleep Disturbances ◽  
Tai Chi ◽  
Mindfulness Meditation ◽  
Behavioral Therapy ◽  
Hippocampal Volume ◽  
Gamma Aminobutyric Acid ◽  
Integrative Health ◽  
Acid Acid ◽  
Military Populations

Insomnia can be a serious problem diminishing quality of life for Veterans and military populations with and without posttraumatic stress disorder (PTSD). Sleep disturbances are one of the symptoms of PTSD but even after evidence-based PTSD treatments, insomnia symptoms often remain. The primary approaches for treating insomnia are cognitive behavioral therapy for insomnia (CBT-I) and pharmacotherapy. However, each of these treatments has drawbacks. Complementary and Integrative Health (CIH) approaches such as mindfulness meditation, mantram meditation, yoga, and tai chi may provide alternative treatments for insomnia in military populations. This paper provides a brief review of studies on CIH interventions for sleep disturbances in Veterans. It also proposes possible mechanisms by which CIH practices may be effective, including increasing hippocampal volume and gamma-aminobutyric acid acid (GABA). Finally, the acceptability of CIH approaches among Veterans is discussed.

“Watch the Screen”: Biofeedback Can Improve Mindfulness for Chronic Pain

Biofeedback ◽  
2018 ◽  
Vol 46 (1) ◽  
pp. 15-20
Author(s):  
Saul Rosenthal
Keyword(s):  
Chronic Pain ◽  
Daily Life ◽  
Behavioral Therapy ◽  
Medical Intervention ◽  
External Signal ◽  
Chronic Pain Management ◽  
Internal Process ◽  
Optimal Approach ◽  
Over Time

Chronic pain has a significant impact on the quality of lives for millions of people. Because it is resistant to traditional medical intervention, the optimal approach to chronic pain management relies on a biopsychosocial understanding of health and treatment. To date, cognitive behavioral therapy (CBT) has been the treatment of choice. However, CBT's emphasis on active control can prove counterproductive because the cognitions, behaviors, and emotions related to pain are difficult to directly confront. More recently, CBT has begun to integrate mindfulness, shifting toward paradigms of accepting sensations rather than trying to change them. This is difficult for individuals with chronic pain, who frequently spend significant resources avoiding and trying to minimize sensations. Biofeedback can be a useful tool for shaping mindfulness because it allows a focus on an external signal that in fact reflects the internal process. Over time, individuals can learn to integrate mindfulness techniques in their daily life that minimize the influence of pain, allowing them to focus on other aspects of their lives.

Chronic Pain and Sleep Disturbances: A Pragmatic Review of Their Relationships, Comorbidities, and Treatments

Pain Medicine ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 1142-1152
Author(s):  
Aubrey J Husak ◽  
Matthew J Bair
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbances ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Pain Severity ◽  
Physically Active ◽  
Duration Of Symptoms ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Pain Duration

Abstract Objective The objective of this review is to answer three questions: 1) How are chronic pain severity and pain duration affected in patients with chronic pain and sleep disturbances that occur simultaneously? 2) What are common comorbidities and pain-related symptoms seen in patients with chronic pain and sleep disturbances? and 3) What are potentially effective pharmacological and nonpharmacological treatment options for both conditions? Methods Ovid Medline and PubMed were searched. Search terms included sleep wake disorder, chronic pain, fibromyalgia, treatment outcome, psychotherapy, complementary therapies, and therapeutics. Studies that assessed outcomes between individuals with chronic pain and those with concurrent chronic pain and sleep disturbances were included. Randomized controlled clinical trials of treatments for both conditions were included. Results Sixteen studies indicated that patients with both chronic pain and sleep disturbances have greater pain severity, longer duration of pain, greater disability, and are less physically active than those without sleep disturbances. Patients with both conditions are more likely to have concurrent depression, catastrophizing, anxiety, and suicidal ideation. Thirty-three randomized controlled trials assessed treatment for both chronic pain and sleep disturbances. Pregabalin was the most frequently studied medication, showing improvement in pain and sleep symptoms. Cognitive behavioral therapy for insomnia showed long-term improvement in sleep for patients with chronic pain. Conclusions Individuals with chronic pain and sleep disturbances have greater symptom severity, longer duration of symptoms, more disability, and additional comorbidities. Pharmacological and nonpharmacological treatments may be useful in the treatment of concurrent chronic pain and sleep disturbances, but further study is needed.

Professionally Directed Non-Pharmacological Management of Chronic Pain (DRAFT)

2018 ◽  
Author(s):  
Peter Przekop
Keyword(s):  
Chronic Pain ◽  
Support Groups ◽  
Tai Chi ◽  
Relaxation Training ◽  
Mindfulness Meditation ◽  
Behavioral Therapy ◽  
Medication Management ◽  
Qi Gong ◽  
Pharmacological Management ◽  
Psychosocial Treatments

This chapter is a complement to Chapter 15, concentrating on the non-pharmacological approaches to chronic pain. It features a discussion on the utility of mind-body therapies, psychosocial treatments, and technology-based therapies in the context of recovery through 12-Step programs and other mutual support groups. Such settings are commonly poorly receptive to medication management of either pain or addiction; the availability of other approaches can bridge the gap, leading to effective management of both. The therapies discussed include “movement” therapies, such as internal qi gong, tai chi, yoga, and martial arts. Healing touch, reiki, external qi gong, and acupuncture are examples of “energy” therapies, requiring an intercessor. Among the psychosocial treatments are motivational interviewing, cognitive restructuring, cognitive behavioral therapy, acceptance-based cognitive therapy, operant training, hypnosis, relaxation training, and mindfulness/meditation. Addressed as procedures are massage, chiropractic and osteopathic manipulations, trans-epidermal nerve stimulation (TENS), and transcranial magnetic stimulation (TMS).

Sleep and pain

2017 ◽  
Author(s):  
Gilles J. Lavigne ◽  
Samar Khoury ◽  
Caroline Arbour ◽  
Nadia Gosselin
Keyword(s):  
Primary Care ◽  
Traumatic Brain Injury ◽  
Chronic Pain ◽  
Temporomandibular Disorders ◽  
Sleep Disturbances ◽  
Poor Sleep ◽  
Sleep Complaints ◽  
Nonrestorative Sleep ◽  
Theoretical Perspectives ◽  
Chronic Pain Conditions

While sleep disturbances are highly prevalent in primary care populations, the patients with the highest rate of poor sleep complaints, including insomnia and nonrestorative sleep, are those with pain. In this chapter, a summary of the potential shared or interactive mechanisms underlying the coexistence of sleep and pain in chronic pain conditions is presented. Theoretical perspectives illustrating sleep–pain interactions are described, as well as the latest empirical evidence regarding sleep disruptions in the context of chronic widespread musculoskeletal pain, fibromyalgia, temporomandibular disorders, headaches, and mild traumatic brain injury. Finally, multidimensional strategies for the co-management of sleep and pain are proposed and discussed.

scholarly journals Chronic Pain Management in Older Adults

2019 ◽  
Vol 42 (2) ◽  
pp. 63-78
Author(s):  
Sirasa Ruangritchankul ◽  
Orapitchaya Krairit
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pharmacological Treatment ◽  
Behavioral Therapy ◽  
Opioid Analgesics ◽  
The Elderly ◽  
Psychological Status ◽  
Chronic Pain Management ◽  
Pharmacological Management ◽  
Pain In The Elderly

Chronic pain in the elderly usually has negative impacts on physical and psychological status, therefore, early diagnosis and treatment should be performed. The principle of chronic pain management is assessment of pathophysiology which leads to different choices of treatment. Furthermore, chronic pain management in the elderly should be combined nonpharmacological such as cognitive-behavioral therapy and pharmacological treatment in order to increase efficacy of pain control. Pharmacological management for chronic pain is composed of 3 categories including nonopioid analgesics, opioid analgesics, and adjuvant medications. The strategies of pharmacological treatment in the elderly are consideration of start with a low dose and slow titration. Moreover, physicians and pharmacists should be aware of drug-drug interactions, drug-disease interactions, as well as adverse drug reactions and events during treatment.  

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