Bothelius K, Jernelöv S, Kaldo V, Lu C, Stråle M-M, Jansson-Fröjmark M
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Internet Interv. 2024 Oct 14;38:100781. doi: 10.1016/j.invent.2024.100781. eCollection 2024 Dec.
Comorbid sleep disturbances are common among individuals with chronic pain, and Cognitive Behavioural Therapy for Insomnia (CBT-i) has proven effective for such individuals. Nonetheless, research on web-based CBT-i tailored for patients with both chronic pain and insomnia is limited. This study aimed to evaluate the feasibility and efficacy of internet-based CBT-i and to explore potential mechanisms underlying treatment outcomes.
In this study, 85 participants suffering from comorbid insomnia and chronic pain were randomized into two groups: Internet-based CBT for Insomnia (ICBT-i) and Internet-based Applied Relaxation (IAR). Both interventions spanned eight weeks, supported by therapeutic guidance throughout.
Participation was modest, with an average module completion of 2.0 out of 8 for ICBT-i and 2.4 for IAR. Both interventions significantly alleviated insomnia symptoms on one of the insomnia measures post-treatment, without notable differences between them. Directly after treatment, IAR outperformed ICBT-i in reducing pain interference, anxiety, and in enhancing self-rated health, though these differences lessened at the 6-month follow-up. Potential therapeutic mechanisms may involve attenuating maladaptive sleep beliefs and augmenting sleep-related willingness.
The study encountered low engagement rates, with approximately one-third of participants not completing any module. The limited efficacy of ICBT-i may be due to low treatment involvement, with few patients completing key techniques like sleep compression and stimulus control. Despite the low adherence, both interventions yielded post-treatment improvements in insomnia symptoms, but to establish internet-based treatments for insomnia as a viable option in chronic pain management, patient engagement must be improved.
共病性睡眠障碍在慢性疼痛患者中很常见，失眠的认知行为疗法（CBT-i）已被证明对这类患者有效。尽管如此，针对慢性疼痛和失眠患者量身定制的基于网络的CBT-i研究仍然有限。本研究旨在评估基于互联网的CBT-i的可行性和疗效，并探索治疗结果背后的潜在机制。
在本研究中，85名患有共病性失眠和慢性疼痛的参与者被随机分为两组：基于互联网的失眠认知行为疗法（ICBT-i）组和基于互联网的应用放松疗法（IAR）组。两种干预措施均为期八周，全程有治疗指导。
参与度一般，ICBT-i组平均完成8个模块中的2.0个，IAR组平均完成2.4个。两种干预措施在治疗后的一项失眠测量指标上均显著减轻了失眠症状，两者之间无显著差异。治疗后即刻，IAR在减轻疼痛干扰、焦虑以及提高自评健康方面优于ICBT-i，不过这些差异在6个月随访时有所减小。潜在的治疗机制可能包括减弱适应不良的睡眠信念和增强与睡眠相关的意愿。
该研究遇到了参与率低的问题，约三分之一的参与者未完成任何模块。ICBT-i疗效有限可能是由于治疗参与度低，很少有患者完成睡眠压缩和刺激控制等关键技术。尽管依从性低，但两种干预措施在治疗后均改善了失眠症状，但要将基于互联网的失眠治疗确立为慢性疼痛管理中的可行选择，必须提高患者的参与度。
