Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, UK.
Behav Res Ther. 2012 Dec;50(12):814-21. doi: 10.1016/j.brat.2012.08.006. Epub 2012 Sep 10.
Insomnia is a debilitating comorbidity of chronic pain. This pilot trial tested the utility of a hybrid treatment that simultaneously targets insomnia and pain-related interference.
Chronic pain patients with clinical insomnia were randomly allocated to receive 4 weekly 2-h sessions of hybrid treatment (Hybrid Group; n = 10) or to keep a pain and sleep diary for 4 weeks, before receiving the hybrid treatment (Monitoring Group; n = 10). Participants were assessed at the beginning and end of this 4-week period. Primary outcomes were insomnia severity and pain interference. Secondary outcomes were fatigue, anxiety, depression and pain intensity. Ancillary information about the hybrid treatment's effect on psychological processes and sleep (as measured with sleep diary and actigraphy) are also presented, alongside data demonstrating the treatment's clinical significance, acceptability and durability after one and six months. Data from all participants (n = 20) were combined for this purpose.
Compared to symptom monitoring, the hybrid intervention was associated with greater improvement in sleep (as measured with the Insomnia Severity Index and sleep diary) at post-treatment. Although pain intensity did not change, the Hybrid Group reported greater reductions in pain interference, fatigue and depression than the Monitoring Group. Overall, changes associated with the hybrid intervention were clinically significant and durable at 1- and 6-month follow-ups. Participants also rated highly on treatment acceptability.
The hybrid intervention appeared to be an effective treatment for chronic pain patients with insomnia. It may be a treatment approach more suited to tackle challenges presented in clinical practice, where problems seldom occur in isolation.
失眠是慢性疼痛的一种使人虚弱的合并症。本试验旨在检验一种同时针对失眠和与疼痛相关的干扰的混合疗法的效用。
患有临床失眠的慢性疼痛患者被随机分配接受每周 2 小时共 4 周的混合治疗（混合组；n=10）或在接受混合治疗前进行 4 周的疼痛和睡眠日记记录（监测组；n=10）。参与者在这 4 周的开始和结束时接受评估。主要结果是失眠严重程度和疼痛干扰。次要结果是疲劳、焦虑、抑郁和疼痛强度。还提供了混合治疗对心理过程和睡眠的影响的辅助信息（通过睡眠日记和活动记录仪测量），以及治疗后 1 个月和 6 个月的临床意义、可接受性和持久性的数据。为此目的，将所有 20 名参与者的数据合并在一起。
与症状监测相比，混合干预与治疗后睡眠（以失眠严重程度指数和睡眠日记测量）的改善更大。尽管疼痛强度没有变化，但混合组报告的疼痛干扰、疲劳和抑郁的减轻比监测组更大。总体而言，混合干预相关的变化在 1 个月和 6 个月的随访中具有临床意义且持久。参与者对治疗的接受度也很高。
混合干预似乎是一种治疗慢性疼痛合并失眠患者的有效方法。它可能是一种更适合解决临床实践中出现的挑战的治疗方法，因为这些问题很少孤立存在。
