University of Rochester Medical Center, Department of Psychiatry, Rochester, NY, USA.
Behav Res Ther. 2012 Nov;50(11):685-9. doi: 10.1016/j.brat.2012.07.005. Epub 2012 Aug 11.
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 bi-directional 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.
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.
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.
CBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia.
慢性疼痛难以治疗，常伴有睡眠障碍，如失眠。反过来，失眠又会加剧疼痛。这两种情况都与炎症过程有关，而炎症过程可能与疼痛和睡眠之间的双向关系有关。认知行为疗法（CBT）用于治疗疼痛和失眠，分别是慢性疼痛和失眠的循证干预措施。本研究的目的是确定联合 CBT 治疗疼痛和失眠的可行性，并评估联合干预和单独干预对疼痛、睡眠和情绪结果的影响，与对照组相比。
21 名同时患有慢性疼痛和慢性失眠的成年人被随机分配到 CBT 治疗疼痛、CBT 治疗失眠、联合 CBT 治疗疼痛和失眠或等待名单对照组。
与对照组相比，联合 CBT 干预措施具有可行性，并显著改善了睡眠、疼痛导致的残疾、抑郁和疲劳。总的来说，与 CBT 治疗疼痛相比，联合干预在大多数结果上似乎具有很强的优势，在减轻慢性疼痛患者的失眠严重程度方面，与 CBT 治疗失眠相比具有适度的优势。
联合 CBT 治疗疼痛和 CBT 治疗失眠可能对同时患有慢性疼痛和失眠的患者有较好的效果。
