Enabling people with persistent pain to sleep well

Dr Dilesh Thaker, Consultant Anaesthetist

Hannah Williams, Clinical Specialist Occupational Therapist

Chris Watson, Clinical Specialist Physiotherapist


Betsi Cadwaladr University Health Board


Background


Estimates suggest that between 50 and 90% of people with persistent pain experience significant sleep problems.


While numerous studies have demonstrated the interdependent relationship between pain and sleep, (disturbance of sleep can increase pain and pain can worsen sleep) evidence suggests the impact of poor sleep on pain is the more significant of the two.


Despite the evidence, many Pain Management Services do not routinely offer formal sleep assistance to patients.


Traditional methods to address sleep problems include Cognitive Behavioural Therapy (CBT), but recent evidence has demonstrated the significant effect of Acceptence and Commitment Therapy (ACT) on sleep quality.

Project Aims


To use Acceptance and Commitment Therapy (ACT) as an intervention to address sleep issues for patients within our Pain Management Service.


To develop an ACT-based, online intervention to help people to learn to be good sleepers again. To our knowledge, this will be the first of its type in Wales.

Challenges

The Covid-19 pandemic put paid to our original intention to run a patient group for the intervention. We responded by working to recreate the course in an online format. To do this, while keeping the content interesting and engaging, has been a learning curve – not least in terms of developing our filming and acting skills!

Key Outcomes

The first run of the intervention will be with a focus group of patients who attended our Pain Management Programme and who assisted us in the developing the content of the sleep course. We will get feedback from them using a semi-structured interview.


We will also use more formal outcome measures with the focus group, and subsequent users. Chief of these is the Pittsburgh Sleep Quality Index, a well-validated questionnaire that measures aspect of sleep across seven domains and distinguishes between good and poor sleepers when scored.


Dr Guy Meadows is a sleep physiologist focusing on the use of ACT in treating insomnia. Given that our intervention has as its basis the ACT principles of accepting and making space for difficult experiences rather than trying to control or get rid of them, we also plan to use Guy Meadows sleep questionnaire. This is not a validated measure but it provides a good idea of how well patients have been able to take an ACT perspective on dealing with their sleep difficulties.

Next Steps

We need to finish filming and creating the content and then get it online for patients to start using.

We would then like to offer it either on its own, for self-directed learning, or with the addition of live clinician input for patients requiring a more intensive guidance.


Finally, when circumstances allow, we would also like to be able to offer the option of a face-to-face group version.

Our Exemplar Experience

Being a Bevan Exemplar has really galvanised us into making this project happen, even with the great challenges of 2020.

Bevan Exemplar Showcase 2021

Contact

Dilesh.thaker@wales.nhs.uk

Hannah.m.williams@wales.nhs.uk

Christopher.watson@wales.nhs.uk