Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice
Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice
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DOI：
10.1093/ptj/pzy020
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发表时间：
2018-05-01
期刊：
影响因子：
3.2
通讯作者：
Goubert, Dorien
中科院分区：
文献类型：
--
作者：
Nijs, Jo;Mairesse, Olivier;Goubert, Dorien
在慢性疼痛患者中，失眠非常普遍，与中枢敏感化机制密切相关，其特征是低度神经炎症，通常与压力或焦虑有关;此外，它通常对药物治疗没有有效反应。这篇综述文章将目前对失眠的认识应用于临床实践，包括慢性疼痛患者失眠的评估和保守治疗。失眠症的认知行为疗法可以有效地改善慢性疼痛患者的睡眠启动，睡眠维持，感知睡眠质量和疼痛干扰日常功能。最近的一项系统性综述得出结论，通过额外的培训，物理治疗师领导的认知行为干预措施对腰痛有效，可以在该领域内实施。失眠的认知行为疗法，如提供给慢性疼痛患者，通常包括教育，睡眠限制措施，刺激控制指令，睡眠卫生和认知疗法。
Among people with chronic pain, insomnia is highly prevalent, closely related to the mechanism of central sensitization, characterized by low-grade neuroinflammation, and commonly associated with stress or anxiety; in addition, it often does not respond effectively to drug treatments. This review article applies the current understanding of insomnia to clinical practice, including assessment and conservative treatment of insomnia in people with chronic pain. Cognitive-behavioral therapy for insomnia can be efficacious for improvements in sleep initiation, sleep maintenance, perceived sleep quality, and pain interference with daily functioning in people with chronic pain. A recent systematic review concluded that with additional training, physical therapist-led cognitive-behavioral interventions are efficacious for low back pain, allowing their implementation within the field. Cognitive-behavioral therapy for insomnia, as provided to people with chronic pain, typically includes education, sleep restriction measures, stimulus control instructions, sleep hygiene, and cognitive therapy.