Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden.
Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
J Med Internet Res. 2022 Apr 29;24(4):e29258. doi: 10.2196/29258.
Patients with chronic pain often experience insomnia symptoms. Pain initiates, maintains, and exacerbates insomnia symptoms, and vice versa, indicating a complex situation with an additional burden for these patients. Hence, the evaluation of insomnia-related interventions for patients with chronic pain is important.
This randomized controlled trial examined the effectiveness of internet-based cognitive behavioral therapy for insomnia (ICBT-i) for reducing insomnia severity and other sleep- and pain-related parameters in patients with chronic pain. Participants were recruited from the Swedish Quality Registry for Pain Rehabilitation.
We included 54 patients (mean age 49.3, SD 12.3 years) who were randomly assigned to the ICBT-i condition and 24 to an active control condition (applied relaxation). Both treatment conditions were delivered via the internet. The Insomnia Severity Index (ISI), a sleep diary, and a battery of anxiety, depression, and pain-related parameter measurements were assessed at baseline, after treatment, and at a 6-month follow-up (only ISI, anxiety, depression, and pain-related parameters). For the ISI and sleep diary, we also recorded weekly measurements during the 5-week treatment. Negative effects were also monitored and reported.
Results showed a significant immediate interaction effect (time by treatment) on the ISI and other sleep parameters, namely, sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. Participants in the applied relaxation group reported no significant immediate improvements, but both groups exhibited a time effect for anxiety and depression at the 6-month follow-up. No significant improvements on pain-related parameters were found. At the 6-month follow-up, both the ICBT-i and applied relaxation groups had similar sleep parameters. For both treatment arms, increased stress was the most frequently reported negative effect.
In patients with chronic pain, brief ICBT-i leads to a more rapid decline in insomnia symptoms than does applied relaxation. As these results are unique, further research is needed to investigate the effect of ICBT-i on a larger sample size of people with chronic pain. Using both treatments might lead to an even better outcome in patients with comorbid insomnia and chronic pain.
ClinicalTrials.gov NCT03425942; https://clinicaltrials.gov/ct2/show/NCT03425942.
慢性疼痛患者常伴有失眠症状。疼痛可引发、维持和加重失眠症状，反之亦然，这表明此类患者情况复杂，负担更重。因此，评估针对慢性疼痛患者的失眠相关干预措施十分重要。
本随机对照试验旨在研究基于互联网的认知行为疗法治疗失眠（ICBT-i）对减轻慢性疼痛患者的失眠严重程度和其他睡眠及疼痛相关参数的效果。研究对象来自瑞典疼痛康复质量登记处。
共纳入 54 名患者（平均年龄 49.3 岁，标准差 12.3 岁），随机分配至 ICBT-i 组和积极对照组（应用放松）。两种治疗方式均通过互联网进行。在基线时、治疗结束时和 6 个月随访时（仅评估 ISI、焦虑、抑郁和疼痛相关参数），分别采用失眠严重程度指数（ISI）、睡眠日记以及焦虑、抑郁和疼痛相关参数的一系列测量方法对患者进行评估。对于 ISI 和睡眠日记，我们还记录了 5 周治疗期间的每周测量值。同时还监测并报告了负面效果。
结果显示，ISI 和其他睡眠参数（睡眠效率、入睡潜伏期、早醒和睡眠后觉醒时间）存在显著的即时治疗间交互效应（时间×治疗）。应用放松组患者的即时改善不显著，但两组患者在 6 个月随访时的焦虑和抑郁均呈现时间效应。疼痛相关参数未见显著改善。在 6 个月随访时，ICBT-i 组和应用放松组的睡眠参数相似。对于两种治疗方法，压力增加是最常报告的负面效果。
在慢性疼痛患者中，与应用放松相比，简短的 ICBT-i 可更快速地降低失眠症状。由于这些结果较为独特，需要进一步研究来评估 ICBT-i 对更大样本量慢性疼痛患者的效果。同时使用两种治疗方法可能会使合并失眠和慢性疼痛的患者获得更好的结果。
ClinicalTrials.gov NCT03425942；https://clinicaltrials.gov/ct2/show/NCT03425942。
