成人共病慢性失眠和纤维肌痛症的认知行为治疗失眠和疼痛：来自 SPIN 随机对照试验的临床结局。
Cognitive behavioral treatments for insomnia and pain in adults with comorbid chronic insomnia and fibromyalgia: clinical outcomes from the SPIN randomized controlled trial.
机构信息
Department of Psychiatry, University of Missouri - Columbia, Columbia, MO.
Department of Clinical and Health Psychology, University of Florida, Gainesville, FL.
出版信息
Sleep. 2019 Mar 1;42(3). doi: 10.1093/sleep/zsy234.
STUDY OBJECTIVES
To examine the effects of cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in patients with comorbid fibromyalgia and insomnia.
METHODS
One hundred thirteen patients (Mage = 53, SD = 10.9) were randomized to eight sessions of CBT-I (n = 39), CBT-P (n = 37), or a waitlist control (WLC, n = 37). Primary (self-reported sleep onset latency [SOL], wake after sleep onset [WASO], sleep efficiency [SE], sleep quality [SQ], and pain ratings) and secondary outcomes (dysfunctional beliefs and attitudes about sleep [DBAS]; actigraphy and polysomnography SOL, WASO, and SE; McGill Pain Questionnaire; Pain Disability Index; depression; and anxiety) were examined at posttreatment and 6 months.
RESULTS
Mixed effects analyses revealed that both treatments improved self-reported WASO, SE, and SQ relative to control at posttreatment and follow-up, with generally larger effect sizes for CBT-I. DBAS improved in CBT-I only. Pain and mood improvements did not differ by group. Clinical significance analyses revealed the proportion of participants no longer reporting difficulties initiating and maintaining sleep was higher for CBT-I posttreatment and for both treatments at 6 months relative to control. Few participants achieved >50% pain reductions. Proportion achieving pain reductions of >30% (~1/3) was higher for both treatments posttreatment and for CBT-I at 6 months relative to control.
CONCLUSIONS
CBT-I and CBT-P improved self-reported insomnia symptoms. CBT-I prompted improvements of larger magnitude that were maintained. Neither treatment improved pain or mood. However, both prompted clinically meaningful, immediate pain reductions in one third of patients. Improvements persisted for CBT-I, suggesting that CBT-I may provide better long-term pain reduction than CBT-P. Research identifying which patients benefit and mechanisms driving intervention effects is needed.
CLINICAL TRIAL
Sleep and Pain Interventions in Fibromyalgia (SPIN), clinicaltrials.gov, NCT02001077.
研究目的
探讨针对合并纤维肌痛和失眠的患者的认知行为治疗失眠（CBT-I）和疼痛（CBT-P）的效果。
方法
113 名患者（Mage=53，SD=10.9）被随机分为 8 节 CBT-I（n=39）、CBT-P（n=37）或等待名单对照（WLC，n=37）。主要（自我报告的入睡潜伏期 [SOL]、睡眠后觉醒时间 [WASO]、睡眠效率 [SE]、睡眠质量 [SQ]和疼痛评分）和次要结果（关于睡眠的功能障碍信念和态度 [DBAS]；活动记录仪和多导睡眠图的 SOL、WASO 和 SE；麦吉尔疼痛问卷；疼痛残疾指数；抑郁；和焦虑）在治疗后和 6 个月时进行检查。
结果
混合效应分析显示，与对照组相比，两种治疗方法在治疗后和随访时均改善了自我报告的 WASO、SE 和 SQ，CBT-I 的效果大小通常更大。仅在 CBT-I 中 DBAS 得到改善。疼痛和情绪改善在组间没有差异。临床意义分析显示，与对照组相比，在治疗后和两种治疗方法在 6 个月时，不再报告入睡和维持睡眠困难的参与者比例更高。很少有参与者达到 >50%的疼痛减轻。与对照组相比，两种治疗方法在治疗后和 CBT-I 在 6 个月时达到 >30%（约 1/3）疼痛减轻的比例更高。
结论
CBT-I 和 CBT-P 改善了自我报告的失眠症状。CBT-I 引起的改善幅度更大且持续。两种治疗方法均未改善疼痛或情绪。然而，两种治疗方法都使三分之一的患者立即出现了有临床意义的疼痛减轻。对于 CBT-I，改善持续存在，这表明 CBT-I 可能比 CBT-P 提供更好的长期疼痛缓解。需要研究确定哪些患者受益以及推动干预效果的机制。
临床试验
纤维肌痛的睡眠和疼痛干预（SPIN），clinicaltrials.gov，NCT02001077。
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