Effectiveness of Cognitive-behavioural Treatments for Insomnia and Pain in Adults with Comorbid Chronic Insomnia and Fibromyalgia

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Effectiveness of Cognitive-behavioural Treatments for Insomnia and Pain in Adults with Comorbid Chronic Insomnia and Fibromyalgia

McCrae CS et al. explained that cognitive behavioural treatments for insomnia (CBT-I) and pain (CBT-P) improved self-reported insomnia symptoms. CBT-I depicted improvements of larger magnitude that were maintained. Neither treatment improved pain or mood. However, both had clinically meaningful, immediate pain reductions in one-third of patients. Improvements persisted for CBT-I, portraying that CBT-I may provide better long-term pain reduction than CBT-P.

Insomnia Disorder is described as having at least three months of difficulty initiating and/or maintaining restorative sleep (DSM-5). It is comorbid with chronic pain, affecting 50% of those with fibromyalgia (FM). This study investigated the effects of cognitive behavioural treatments for insomnia (CBT-I) and pain (CBT-P) in patients with comorbid fibromyalgia and insomnia.

McCrae CS et al. randomized 113 patients (Mage=53) to eight sessions of CBT-I (n=39), CBT-P (n=37), or a waitlist control (WLC, n=37). The primary namely self-reported sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), sleep quality (SQ), pain ratings) and secondary outcomes namely dysfunctional attitudes about sleep (DBAS); actigraphy and polysomnography SOL, WASO, and SE; McGill Pain Questionnaire; Pain Disability Index; depression; anxiety was assessed post-treatment and 6-months.

It was found that both the treatments improved self-reported WASO, SE, and SQ at compared to control at post-treatment and follow-up, with generally larger effect sizes for CBT-I. The DBAS improved only in CBT-I. Pain and mood improvements did not vary by group. Clinical significance analyses depicted that the proportion of participants no longer reporting difficulties initiating and maintaining sleep was higher for CBT-I post-treatment and both treatments at 6-months relative to the control. Only a few participants fulfilled >50% pain reductions. Proportion attaining pain reductions >30% (~1/3) was higher for both the treatments post-treatment and for CBT-I at 6-months relative to control.

Future research underlying the patients' benefit and mechanisms driving intervention effects are required.

Source

Sleep

Link:

https://www.ncbi.nlm.nih.gov/pubmed/30496533

Original title of article

Cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in adults with comorbid chronic insomnia and fibromyalgia: Clinical outcomes from the SPIN randomized controlled trial

Authors:

McCrae CS et al.

SearchTags: 
Exploratory, Fibromyalgia, Insomnia, Pain, Randomized controlled trial, Primary [self-reported sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), sleep quality (SQ), pain ratings), Dysfunctional attitudes about sleep (DBAS), McGill Pain Questionnaire; Pain Disability Index
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