Zambelli Zoe, Halstead Elizabeth J, Fidalgo Antonio R, Mangar Stephen, Dimitriou Dagmara
Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom.
School of Psychology, University of East London, London, United Kingdom.
Front Psychol. 2024 Jan 11;14:1266368. doi: 10.3389/fpsyg.2023.1266368. eCollection 2023.
A large proportion of individuals with chronic pain experience insomnia-related symptoms which can be persistent in nature, and negatively impact one's quality of life. This single arm trial aimed to investigate the feasibility and preliminary efficacy of CBT-I, adapted for people with chronic musculoskeletal pain, delivered via telehealth.
We conducted a single arm feasibility trial in which 10 adult women (M age = 50.76 years, SD = 8.03 years) with self-reported insomnia and a diagnosed chronic musculoskeletal chronic pain received six CBT-I individual treatment sessions over 6-10 weeks. Treatment was delivered via telehealth. Participants completed weekly sleep diaries, and self-reported measures of insomnia, pain, anxiety and depression pre-treatment, post-treatment, and one-month follow-up.
The trial yielded, high levels of compliance with intervention protocols, and affirmative feedback on satisfaction which demonstrated feasibility. The enrolment rate into the study was 37% (27 participants screened, 10 participants enrolled). The intervention was associated with statistically and clinically meaningful improvements in self-reported insomnia severity. There were statistically significant improvements in sleep efficiency, wake after sleep onset, sleep onset latency, anxiety and depression.
Adapted CBT-I delivered via telehealth may be a feasible, acceptable, and efficacious therapeutic approach for individuals with co-existent sleep and chronic pain. Future trials should adopt a randomized design against usual care.
很大一部分慢性疼痛患者会经历与失眠相关的症状，这些症状可能持续存在，并对个人生活质量产生负面影响。这项单臂试验旨在研究通过远程医疗为慢性肌肉骨骼疼痛患者提供的认知行为疗法失眠治疗（CBT-I）的可行性和初步疗效。
我们进行了一项单臂可行性试验，10名自我报告有失眠症状且被诊断患有慢性肌肉骨骼慢性疼痛的成年女性（平均年龄=50.76岁，标准差=8.03岁）在6至10周内接受了6次CBT-I个体治疗课程。治疗通过远程医疗进行。参与者在治疗前、治疗后和1个月随访时完成每周睡眠日记，以及关于失眠、疼痛、焦虑和抑郁的自我报告测量。
该试验显示出对干预方案的高度依从性，以及关于满意度的肯定反馈，证明了可行性。该研究的入组率为37%（筛查27名参与者，10名参与者入组）。干预与自我报告的失眠严重程度在统计学和临床上有意义的改善相关。睡眠效率、睡眠开始后觉醒、睡眠开始潜伏期、焦虑和抑郁有统计学上的显著改善。
通过远程医疗提供的适应性CBT-I可能是一种对同时存在睡眠和慢性疼痛的个体可行、可接受且有效的治疗方法。未来的试验应采用针对常规护理的随机设计。
