Professor Jo Nijs
Professor, Vrije Universiteit Brussel, Belgium
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Jo Nijs is professor at the Vrije Universiteit Brussel (Brussels, Belgium), physiotherapist/manual therapist at the University Hospital Brussels, holder of a Chair on oncological physiotherapy funded by the Berekuyl Academy, the Netherlands, and Visiting Professor at the University of Gothenburg (Sweden).
Jo runs the Pain in Motion international and interdisciplinary research group (www.paininmotion.be). The primary aim of his research is improving care for patients with chronic pain. At the age of 46, he has (co-)authored >300 peer reviewed publications (including papers in high impact journals such as The Lancet, JAMA Neurology and The Lancet Rheumatology), obtained €13 million grant income, supervised 23 PhD’s to completion and served >300 times as an invited speaker at meetings in 25 countries (including 37 keynotes). He trained >3k clinicians in 101 courses held in 12 countries spread over 4 continents. His work has been cited >10k times (h-index: 57), with 33 citations per article (ISI Web of Knowledge). Jo is ranked 2nd in the world among chronic pain researchers (1st in Europe; expertscape.com), received the 2017 Excellence in Research Award from the JOSPT (USA), and the 2020 Francqui Collen Chair awarded by the University of Hasselt, Belgium. Website: https://researchportal.vub.be/en/persons/jo-nijs |
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Pain Never Sleeps: Why and How to Integrate Sleep Management in the Treatment for Patients with Chronic Pain
Chronic pain has a tremendous personal and socioeconomic impact. Lifestyle factors such as physical (in)activity, sedentary behaviour, stress, poor sleep, unhealthy diet and smoking are associated with chronic pain severity and sustainment1-5. This applies to all age categories, i.e. chronic pain across the lifespan. Yet current treatment options often do not, or only partly address the many lifestyle factors associated with chronic pain, or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention1,5-7. Therefore, this lecture focusses on one key lifestyle factor that is often overlooked and rarely addressed thoroughly: sleep.
Among many people with chronic pain, including patients with osteoarthritis, low back pain, neck pain, post-cancer pain, neuropathic pain, headache and fibromyalgia, insomnia is highly prevalent, closely related to the mechanism of central sensitization, characterized by low-grade neuroinflammation, commonly associated with stress or anxiety, and often does not respond effectively to drug treatments8. This lecture applies the current understanding of insomnia to clinical practice, including assessment and conservative treatment of insomnia in people with chronic pain9. Cognitive behavioural therapy for insomnia (CBT-I) can be efficacious in improvements of sleep initiation, sleep maintenance, perceived sleep quality and pain interference with daily functioning in people with chronic pain. With additional training, physiotherapist-led cognitive-behavioral interventions are efficacious for spinal pain, allowing their implementation within the field. CBT-I, as provided to people with chronic pain, typically includes sleep education, sleep restriction measures, stimulus control instructions, sleep hygiene, and cognitive therapy. This is an exciting, innovative area for the physiotherapy profession. This new development holds great potential for improving care for the many patients with persistent pain who have sleep problems.
Among many people with chronic pain, including patients with osteoarthritis, low back pain, neck pain, post-cancer pain, neuropathic pain, headache and fibromyalgia, insomnia is highly prevalent, closely related to the mechanism of central sensitization, characterized by low-grade neuroinflammation, commonly associated with stress or anxiety, and often does not respond effectively to drug treatments8. This lecture applies the current understanding of insomnia to clinical practice, including assessment and conservative treatment of insomnia in people with chronic pain9. Cognitive behavioural therapy for insomnia (CBT-I) can be efficacious in improvements of sleep initiation, sleep maintenance, perceived sleep quality and pain interference with daily functioning in people with chronic pain. With additional training, physiotherapist-led cognitive-behavioral interventions are efficacious for spinal pain, allowing their implementation within the field. CBT-I, as provided to people with chronic pain, typically includes sleep education, sleep restriction measures, stimulus control instructions, sleep hygiene, and cognitive therapy. This is an exciting, innovative area for the physiotherapy profession. This new development holds great potential for improving care for the many patients with persistent pain who have sleep problems.
Key references
1. Nijs J, D'Hondt E, Clarys P, Deliens T, Polli A, Malfliet A, Coppieters I, Willaert W, Tumkaya Yilmaz S, Elma Ö, Ickmans K. Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth? PM & R : the journal of injury, function, and rehabilitation 2020; 12(4): 410-9.
2. Malfliet A, Marnef AQ, Nijs J, Clarys P, Huybrechts I, Elma Ö, Tumkaya SY, Deliens T. Obesity Hurts: The why and how of Integrating Weight Reduction with Chronic Pain Management. Physical therapy 2021.
3. Vitiello MV, McCurry SM, Shortreed SM, Balderson BH, Baker LD, Keefe FJ, Rybarczyk BD, Von Korff M. Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial. Journal of the American Geriatrics Society 2013; 61(6): 947-56.
4. Okifuji A, Hare BD. The association between chronic pain and obesity. Journal of pain research 2015; 8: 399-408.
5. Torres-Ferrus M, Vila-Sala C, Quintana M, Ajanovic S, Gallardo VJ, Gomez JB, Alvarez-Sabin J, Macaya A, Pozo-Rosich P. Headache, comorbidities and lifestyle in an adolescent population (The TEENs Study). Cephalalgia : an international journal of headache 2018: 333102418777509.
6. Nijs J, George SZ, Clauw DJ, Fernández-de-las-Peñas C, Kosek E, Ickmans K, Fernández-Carnero J, Polli A, Kapreli E, Huysmans E, Cuesta-Vargas AI, Mani R, Lundberg M, Leysen L, Rice D, Sterling M, Curatolo M. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. The Lancet Rheumatology 2021; 3(5): e383-e92.
7. Gutke A, Sundfeldt K, De Baets L. Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions. Journal of clinical medicine 2021; 10(22): 5397.
8. Nijs J, Mairesse O, Neu D, Leysen L, Danneels L, Cagnie B, Meeus M, Moens M, Ickmans K, Goubert D. Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Physical therapy 2018; 98(5): 325-35.
9. Herrero Babiloni A, Beetz G, Tang NKY, Heinzer R, Nijs J, Martel MO, Lavigne GJ. Towards the endotyping of the sleep-pain interaction: a topical review on multitarget strategies based on phenotypic vulnerabilities and putative pathways. Pain 2021; 162(5): 1281-8.
1. Nijs J, D'Hondt E, Clarys P, Deliens T, Polli A, Malfliet A, Coppieters I, Willaert W, Tumkaya Yilmaz S, Elma Ö, Ickmans K. Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth? PM & R : the journal of injury, function, and rehabilitation 2020; 12(4): 410-9.
2. Malfliet A, Marnef AQ, Nijs J, Clarys P, Huybrechts I, Elma Ö, Tumkaya SY, Deliens T. Obesity Hurts: The why and how of Integrating Weight Reduction with Chronic Pain Management. Physical therapy 2021.
3. Vitiello MV, McCurry SM, Shortreed SM, Balderson BH, Baker LD, Keefe FJ, Rybarczyk BD, Von Korff M. Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial. Journal of the American Geriatrics Society 2013; 61(6): 947-56.
4. Okifuji A, Hare BD. The association between chronic pain and obesity. Journal of pain research 2015; 8: 399-408.
5. Torres-Ferrus M, Vila-Sala C, Quintana M, Ajanovic S, Gallardo VJ, Gomez JB, Alvarez-Sabin J, Macaya A, Pozo-Rosich P. Headache, comorbidities and lifestyle in an adolescent population (The TEENs Study). Cephalalgia : an international journal of headache 2018: 333102418777509.
6. Nijs J, George SZ, Clauw DJ, Fernández-de-las-Peñas C, Kosek E, Ickmans K, Fernández-Carnero J, Polli A, Kapreli E, Huysmans E, Cuesta-Vargas AI, Mani R, Lundberg M, Leysen L, Rice D, Sterling M, Curatolo M. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. The Lancet Rheumatology 2021; 3(5): e383-e92.
7. Gutke A, Sundfeldt K, De Baets L. Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions. Journal of clinical medicine 2021; 10(22): 5397.
8. Nijs J, Mairesse O, Neu D, Leysen L, Danneels L, Cagnie B, Meeus M, Moens M, Ickmans K, Goubert D. Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Physical therapy 2018; 98(5): 325-35.
9. Herrero Babiloni A, Beetz G, Tang NKY, Heinzer R, Nijs J, Martel MO, Lavigne GJ. Towards the endotyping of the sleep-pain interaction: a topical review on multitarget strategies based on phenotypic vulnerabilities and putative pathways. Pain 2021; 162(5): 1281-8.
