Most people who have nonspecific chronic spinal
pain (nCSP) report comorbid
insomnia. However, in current treatment strategies for nCSP,
insomnia is usually not addressed. Considering the bidirectional interaction between
pain and sleep and its underlying psychophysiological mechanisms,
insomnia may increase the risk of developing adverse physical and psychological health outcomes and should thus no longer be left untreated. As suggested by previous pilot studies, adding cognitive behavioral therapy for
insomnia to the contemporary evidence-based biopsychosocial
physical therapy approach may also improve
pain outcomes in nCSP. This manuscript aims to provide practical guidelines on hybrid
physical therapy, including the combination of the following components: (1)
pain neuroscience education (eg, to reconceptualize
pain) and cognition-targeted
exercise therapy (eg, graded exposure to functional daily life movements), and (2) cognitive behavioral therapy for
insomnia (sleep psychoeducation, behavioral and cognitive therapy, correction of sleep hygiene, and
relaxation therapy) can be deployed for the management of patients who have chronic spinal
pain. Impact. Due to the major impact sleep disturbances have on
pain and disability,
insomnia as a comorbidity should no longer be ignored when treating patients with chronic spinal
pain.