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Due to significant
improvement in sleep quality and pain-related symptoms, the use of CBT should
be considered in adults with comorbid chronic insomnia and fibromyalgia.
The results of SPIN randomized controlled trial 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 outcomes 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.The proportion of
participants no longer reporting difficulties initiating and maintaining sleep
were higher in 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.
Sleep
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
McCrae CS et al.
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