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Doctor, I have chronic pain and difficulty sleeping. Are there any non-drug treatments I can use to help me sleep?

Cognitive behavioural therapy focused on insomnia may help some people with chronic pain sleep better.

What is the evidence?


Cognitive behavioural therapy for insomnia vs no treatment/wait list/attentional control at up to 6 months

OutcomeNo. of studiesEffectQuality of Evidence

Sleep quality (measured using a questionnaire)

Immediately after treatment9 (386 people)large improvement in sleep quality compared to no treatment/wait list/attentional control

3 out 9 studies low risk of bias^

3 months after treatment2 (166 people)No effect
6 months after treatment3 (136 people)medium improvement in sleep quality compared to no treatment/wait list/attentional control

Pain (measured using a questionnaire)

Immediately after treatment9 (370 people)small improvement in pain compared to no treatment/wait list/attentional control3 out of 9 studies low risk of bias^
3 months after treatment3 (166 people)No effect
6 months after treatment3 (136 people)No effect

*other non-drug options to improve sleep were reviewed, but CBT-I was the one with the largest amount of data to combine together

^low risk of bias = low risk the study has method or design errors that would affect the accuracy of the results

What kind of study was this?

This was a systematic review of 42 randomized controlled studies published up to April 2020.

Who? This review included 3,346 adults (average age 53 years) with chronic pain (pain lasting longer than 3 months) due to conditions such as fibromyalgia, osteoarthritis, and diverse chronic pain.

What? The reviewers included studies that compared non-drug treatments to improve sleep with no treatment/wait list/attentional control.

Non-drug treatments to improve sleep


No treatment/wait list/attention control

Cognitive behaviour therapy focused on insomnia (CBT-I): a type of talking therapy that teaches a person how to manage their sleep by thinking and behaving in a more positive way. Delivered by professionals (clinical psychologists, psychiatric nurses, graduate student therapists) in weekly sessions over 4 to 10 weeks.

Other non-drug interventions: sleep hygiene (healthy habits and bedroom environment that promotes sleep), acceptance and commitment therapy, mindfulness, relaxation, exercise, hydrotherapy, massage or manual therapy, Tai Ji Quan, pompage, acupressure, bright light treatment, foot reflexology, magnetic mattress pad

Wait list: no specific treatment provided while waiting to receive CBT-I

Attentional control: people are given attention by researchers without being given any of the treatments

Why was this research done?

About two out of every three people with chronic pain experience problems with sleeping including falling asleep, staying asleep, and waking up early. Poor sleep quality can make chronic pain worse by making nerves more sensitive to pain and making it more difficult for people to cope with pain. The reviewers wanted to know if non-drug treatments improve sleep quality and reduce pain in people with difficulty sleeping. They found moderate quality evidence that cognitive behaviour therapy focused on insomnia (CBT-I) improved sleep quality in the short-term. More longer term studies need to be done to find ways to maintain the improvements. Concerns about this review include the small size of most of the studies, differences in the treatments provided, and unclear risk of bias for half of the included studies.

This Evidence Summary is based on the following article:

Whale K, Dennis J, Wylde V, et al. The effectiveness of non-pharmacological sleep interventions for people with chronic pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2022 May 11;23(1):440. doi: 10.1186/s12891-022-05318-5. PubMed

Published: Tuesday, August 23, 2022

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.