Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Ontario, Canada.
Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Western University, London, ON, Canada.
Sleep Med Rev. 2021 Dec;60:101460. doi: 10.1016/j.smrv.2021.101460. Epub 2021 Feb 2.
Several randomized controlled trials have implemented cognitive behavioral therapy for insomnia (CBT-I) for patients with comorbid insomnia and chronic pain. This systematic review and meta-analysis investigated the effectiveness of CBT-I on patient-reported sleep, pain, and other health outcomes (depressive symptoms, anxiety symptoms, and fatigue) in patients with comorbid insomnia and chronic non-cancer pain. A systematic literature search was conducted using eight electronic databases. Upon duplicate removal, 6374 records were screened against the inclusion criteria. Fourteen randomized controlled trials were selected for the review, with twelve (N = 762 participants) included in the meta-analysis. At post-treatment, significant treatment effects were found on global measures of sleep (standardized mean difference = 0.89), pain (0.20), and depressive symptoms (0.44). At follow-up (up to 12 mo), CBT-I significantly improved sleep (0.56). Using global measures of sleep, we found a probability of 81% and 71% for having better sleep after CBT-I at post-treatment and final follow-up, respectively. The probability of having less pain after CBT-I at post-treatment and final follow-up was 58% and 57%, respectively. There were no statistically significant effects on anxiety symptoms and fatigue at either assessment point. Future trials with sufficient power, longer follow-up periods, and inclusion of CBT for pain components are warranted.
几项随机对照试验已经为合并失眠和慢性疼痛的患者实施了认知行为疗法（CBT-I）。本系统评价和荟萃分析调查了 CBT-I 对合并失眠和慢性非癌性疼痛患者的睡眠、疼痛和其他健康结果（抑郁症状、焦虑症状和疲劳）的有效性。使用八个电子数据库进行了系统文献检索。经过重复去除，根据纳入标准筛选出 6374 条记录。选择了 14 项随机对照试验进行综述，其中 12 项（N=762 名参与者）纳入荟萃分析。在治疗后，睡眠（标准化均数差=0.89）、疼痛（0.20）和抑郁症状（0.44）的总体测量指标显示出显著的治疗效果。在随访（长达 12 个月）时，CBT-I 显著改善了睡眠（0.56）。使用睡眠的总体测量指标，我们发现，在治疗后和最终随访时，接受 CBT-I 治疗后睡眠更好的概率分别为 81%和 71%。在治疗后和最终随访时，疼痛减轻的概率分别为 58%和 57%。在任何评估点，CBT-I 对焦虑症状和疲劳均无统计学显著影响。未来的试验需要有足够的效力、更长的随访期，并纳入疼痛治疗部分的 CBT。
