Insomnia in clients with chronic, work-related musculoskeletal pain in a work recovery rehabilitation program

BACKGROUND: There is a high prevalence of sleep disturbance with people experiencing chronic pain. Although multi-disciplinary rehabilitation programs address many contributing factors for chronic pain, the impact of insomnia on clients is not often measured. OBJECTIVE: Two studies were used to: first explore the experience of insomnia in a group of clients with chronic pain and then, in a group enrolled in a six-week work recovery rehabilitation program, compare measures of sleep disturbance at entry and upon its completion. PARTICIPANTS: Sixteen clients participated in focus groups and 29 completed questionnaires; 46% were women and the average age was 43 years. They had a wide range of work-related musculoskeletal injuries and all had chronic pain. METHODS: First two, semi-structured focus group interviews explored sleep disturbance. Then a different set of participants completed three sleep questionnaires before and after completing a rehabilitation program. RESULTS: Focus group participants described sleep disturbance consistent with clinical insomnia and how it had a considerable impact on their lives. Completed questionnaires confirmed the presence of sleep disturbance at admission into a six-week rehabilitation program and at discharge, most measures were unchanged. CONCLUSIONS: Although chronic pain rehabilitation generally includes interdisciplinary approaches, specific attention to insomnia is not part of this chronic pain rehabilitation program and therefore it is not surprising that there was no appreciable change by the end of the program. However, because sleep disturbance is prevalent in the chronic pain population and in this sample, and has such a strong impact on the individual's daytime functioning, effective interventions directed at sleep restriction and stimulus control should complement chronic pain rehabilitation programs.