Wilson Keith G, Kowal John, Ferguson Emma J
*Department of Psychology, The Ottawa Hospital Rehabilitation Centre †Clinical Epidemiology Program, The Ottawa Hospital Research Institute Departments of ‡Medicine ∥Anaesthesiology §School of Psychology, University of Ottawa, Ottawa, ON, Canada.
Clin J Pain. 2016 Sep;32(9):784-91. doi: 10.1097/AJP.0000000000000325.
Insomnia is a common problem for people with chronic pain. It is unclear, however, whether interdisciplinary treatment centered on pain management, rather than sleep, confers a benefit in reducing insomnia symptoms. In this study, we examined clinically important change in insomnia severity following participation in an interdisciplinary chronic pain rehabilitation program.
A total of 140 patients (43 men and 97 women) completed a 4-week outpatient day program for interdisciplinary rehabilitation that incorporated psychoeducation about pain, physical fitness, and group psychotherapy. The Insomnia Severity Index (ISI) was included as an outcome, along with measures of pain, mood, and function.
On the ISI before treatment, 20 patients (14.3%) reported no insomnia, 36 (25.7%) had a mild or subthreshold problem, and 84 (60%) had moderate (31.4%) or severe (28.6%) clinical insomnia. After treatment, ISI scores showed a statistically significant improvement overall (P<0.001). Six indices of individual change were examined among those with moderate-severe insomnia at baseline. Depending on the index used, rates of clinically important improvement ranged from 2.4% to 47.6%; however, only 2 patients with insomnia met criteria for full remission. Among patients with no or subthreshold symptoms at baseline, from 0% to 14.3% were worse after treatment, depending on the criterion.
Insomnia improves overall following interdisciplinary rehabilitation for chronic pain, but most patients with clinical insomnia continue to have a significant sleep problem after treatment, and some patients may get worse. Interventions to alleviate persistent insomnia comorbid with chronic pain are likely to require a more intensive focus on sleep itself.
失眠是慢性疼痛患者的常见问题。然而，以疼痛管理而非睡眠为中心的跨学科治疗是否有助于减轻失眠症状尚不清楚。在本研究中，我们考察了参与跨学科慢性疼痛康复项目后失眠严重程度的临床重要变化。
共有140名患者（43名男性和97名女性）完成了为期4周的跨学科康复门诊日间项目，该项目包括疼痛心理教育、体能训练和团体心理治疗。将失眠严重程度指数（ISI）作为一项结果指标，同时纳入疼痛、情绪和功能的测量指标。
治疗前的ISI显示，20名患者（14.3%）报告无失眠，36名（25.7%）有轻度或阈下问题，84名（60%）有中度（31.4%）或重度（28.6%）临床失眠。治疗后，ISI评分总体上有统计学显著改善（P<0.001）。对基线时患有中度至重度失眠的患者，检查了六个个体变化指标。根据所使用的指标，临床重要改善率在2.4%至47.6%之间；然而，只有2名失眠患者达到完全缓解标准。在基线时无或有阈下症状的患者中，根据标准，0%至14.3%的患者治疗后情况变差。
慢性疼痛的跨学科康复后失眠总体上有所改善，但大多数临床失眠患者治疗后仍有明显的睡眠问题，部分患者情况可能变差。缓解与慢性疼痛共病的持续性失眠的干预措施可能需要更专注于睡眠本身。
