Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study

Abstract

Introduction Chronic pain is difficult to treat and often precedes or exacerbates sleep disturbances such as insomnia. Insomnia, in turn, can amplify the pain experience. Both conditions are associated with inflammatory processes, which may be involved in the bidirectional relationship between pain and sleep. Cognitive behavioral therapy (CBT) for pain and CBT for insomnia are evidence based interventions for, respectively, chronic pain and insomnia. The study objectives were to determine the feasibility of combining CBT for pain and for insomnia and to assess the effects of the combined intervention and the stand alone interventions on pain, sleep, and mood outcomes compared to a control condition. Methods Twenty-one adults with co-occurring chronic pain and chronic insomnia were randomized to either CBT for pain, CBT for insomnia, combined CBT for pain and insomnia, or a wait-list control condition. Results The combined CBT intervention was feasible to deliver and produced significant improvements in sleep, disability from pain, depression and fatigue compared to the control condition. Overall, the combined intervention appeared to have a strong advantage over CBT for pain on most outcomes, modest advantage over both CBT for insomnia in reducing insomnia severity in chronic pain patients. Discussion CBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia.

The role of insomnia in the treatment of chronic fatigue

“…Thus, improved sleep quality may improve the physiological response to stress for these patients and could be a potential mechanism of change in the treatment of CFS. Palesh et al found that sleep disruption was related to a flattened cortisol response on the TSST (43). Our result is in line with this, though we found that for patients who already displayed a flattened cortisol response on the TSST, improved insomnia severity is related to having improved cortisol response.…”

Physical and Cognitive-Affective Factors Associated With Fatigue in Individuals With Fibromyalgia: A Multiple Regression Analysis

“…Lastly, treatment strategies that rehabilitation professionals can use to help individuals with FM fatigue to adjust to the pain rehabilitation process include cognitive-behavioral intervention approaches, education, pharmacological therapies, and graded or low-intensity exercise strategies (Guymer & Clauw, 2002). There is also emerging evidence showing that cognitive-behavioral strategies may help individuals with insomnia and other FM symptoms (Edinger, Wohlgemuth, Krystal, & Rice, 2005;Pigeon et al, 2012).…”

Cognitive Behavioral Therapy in the Treatment of Insomnia

“…Studies that the previous AHRQ review assessed as poor quality were excluded from our review. 26 One investigator extracted relevant study, population demographic, and outcomes data. Outcomes data used in analyses were confirmed by a second investigator.…”

“…Unfortunately, methodological limitations have prevented conclusive evidence synthesis for these treatments. [21][22][23][24][25][26][27][28][29][30] Insomnia treatment goals include meaningful improvements in sleep and associated distress and/or dysfunction. Insomnia treatment may affect several types of outcomes.…”