Internet-Delivered Cognitive Behavioral Therapy for Insomnia Comorbid With Chronic Pain: Randomized Controlled Trial.
CBT-i
RCT
chronic pain
comorbid
digital health
insomnia
mental health
online health
online treatment
pain
rehabilitation
web-based CBT
Journal
Journal of medical Internet research
ISSN: 1438-8871
Titre abrégé: J Med Internet Res
Pays: Canada
ID NLM: 100959882
Informations de publication
Date de publication:
29 04 2022
29 04 2022
Historique:
received:
31
03
2021
accepted:
09
02
2022
revised:
26
07
2021
entrez:
29
4
2022
pubmed:
30
4
2022
medline:
4
5
2022
Statut:
epublish
Résumé
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.
Sections du résumé
BACKGROUND
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.
OBJECTIVE
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.
METHODS
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
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.
CONCLUSIONS
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.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03425942; https://clinicaltrials.gov/ct2/show/NCT03425942.
Identifiants
pubmed: 35486418
pii: v24i4e29258
doi: 10.2196/29258
pmc: PMC9107050
doi:
Banques de données
ClinicalTrials.gov
['NCT03425942']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
e29258Informations de copyright
©Tobias Wiklund, Peter Molander, Philip Lindner, Gerhard Andersson, Björn Gerdle, Elena Dragioti. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.04.2022.
Références
CMAJ. 2016 Mar 1;188(4):263-272
pubmed: 26527829
Health Qual Life Outcomes. 2018 Sep 14;16(1):182
pubmed: 30217206
J Consult Clin Psychol. 2005 Dec;73(6):1164-74
pubmed: 16392989
Headache. 2003 Apr;43(4):353-61
pubmed: 12656706
Sleep Med Rev. 2021 Dec;60:101460
pubmed: 33610967
Psychiatry Res. 2008 Sep 30;160(3):335-45
pubmed: 18718673
Ann Intern Med. 2015 Aug 4;163(3):191-204
pubmed: 26054060
Sleep. 2006 Sep;29(9):1155-73
pubmed: 17040003
Sleep. 2017 Jan 01;40(1):
pubmed: 28364456
Arthritis Rheum. 2012 Jan;64(1):281-4
pubmed: 22081440
Arch Intern Med. 2006 May 22;166(10):1092-7
pubmed: 16717171
Behav Res Ther. 2009 Mar;47(3):175-80
pubmed: 19230862
Sleep Med. 2010 Mar;11(3):302-9
pubmed: 20133188
CNS Drugs. 2004;18(5):285-96
pubmed: 15089114
J Consult Clin Psychol. 2004 Feb;72(1):113-20
pubmed: 14756620
J Clin Med. 2019 Jun 24;8(6):
pubmed: 31238588
Eur J Pain. 2006 May;10(4):287-333
pubmed: 16095934
J Thorac Dis. 2018 Jan;10(Suppl 1):S94-S102
pubmed: 29445533
Sleep Disord. 2012;2012:679648
pubmed: 23470897
PLoS One. 2016 Jun 22;11(6):e0157503
pubmed: 27331907
Lancet. 2012 Dec 15;380(9859):2163-96
pubmed: 23245607
Annu Rev Clin Psychol. 2011;7:435-58
pubmed: 17716026
Depress Anxiety. 2009;26(3):235-42
pubmed: 19212970
Internet Interv. 2016 Oct 03;6:107-114
pubmed: 30135819
Arch Phys Med Rehabil. 1994 Oct;75(10):1082-6
pubmed: 7944912
Clin Neurophysiol. 2006 Jul;117(7):1574-81
pubmed: 16679057
J Sleep Res. 2016 Apr;25(2):131-43
pubmed: 26762182
Front Psychiatry. 2018 Aug 28;9:377
pubmed: 30210367
Clin J Pain. 2012 Jun;28(5):428-36
pubmed: 22179550
Rheumatology (Oxford). 2007 Apr;46(4):666-71
pubmed: 17085772
J Psychosom Res. 2009 Aug;67(2):109-16
pubmed: 19616137
Sleep. 2015 Nov 01;38(11):1751-64
pubmed: 25902806
Sleep. 2020 Nov 12;43(11):
pubmed: 32421814
Expert Rev Pharmacoecon Outcomes Res. 2012 Dec;12(6):745-64
pubmed: 23252357
Sleep. 2011 May 01;34(5):601-8
pubmed: 21532953
Behav Res Ther. 2002 Jan;40(1):75-83
pubmed: 11762429
J Clin Sleep Med. 2009 Aug 15;5(4):355-62
pubmed: 19968014
Behav Cogn Psychother. 2019 Sep;47(5):559-572
pubmed: 30871650
J Rehabil Med. 2017 Jan 19;49(1):63-70
pubmed: 27904908
Curr Sleep Med Rep. 2017;3(2):48-56
pubmed: 28553574
Phys Ther. 2014 Apr;94(4):499-510
pubmed: 24231224
Pain. 1996 Dec;68(2-3):363-8
pubmed: 9121825
Transl Behav Med. 2014 Dec;4(4):407-23
pubmed: 25584090
J Clin Sleep Med. 2008 Oct 15;4(5):487-504
pubmed: 18853708
Scand J Pain. 2017 Dec 29;9(1):22-27
pubmed: 29911642
Cogn Behav Ther. 2009;38(4):196-205
pubmed: 20183695
Behav Sleep Med. 2019 Mar-Apr;17(2):137-155
pubmed: 28345961
Sleep Med Clin. 2014 Jun 1;9(2):261-274
pubmed: 25477769
Sleep Med Rev. 2018 Dec;42:127-138
pubmed: 30177248
Sleep Med. 2001 Jul;2(4):297-307
pubmed: 11438246
Behav Res Ther. 2015 Jul;70:47-55
pubmed: 25981329
BMC Gastroenterol. 2011 Oct 12;11:110
pubmed: 21992655
Sleep. 2019 Mar 1;42(3):
pubmed: 30496533
Pain. 2011 Oct;152(10):2399-2404
pubmed: 21856077
Pain. 1990 Feb;40(2):171-182
pubmed: 2308763
J Abnorm Psychol. 1974 Jun;83(3):253-60
pubmed: 4844912
J Grad Med Educ. 2012 Sep;4(3):279-82
pubmed: 23997866
J Sleep Res. 2020 Apr;29(2):e12967
pubmed: 31856367
Clin J Pain. 2011 Jun;27(5):425-33
pubmed: 21415723
J Gen Intern Med. 2001 Sep;16(9):606-13
pubmed: 11556941
Behav Res Ther. 1987;25(5):397-409
pubmed: 3318800
Disabil Rehabil. 2014;36(20):1661-9
pubmed: 24320022
Sleep Med Rev. 2015 Oct;23:83-8
pubmed: 25771293
J Med Internet Res. 2020 Dec 18;22(12):e24268
pubmed: 33264099
J Clin Sleep Med. 2016 Sep 15;12(9):1269-77
pubmed: 27448428
Sleep Med Rev. 2018 Apr;38:3-16
pubmed: 28392168
Clin J Pain. 2011 Oct;27(8):716-23
pubmed: 21540740
Pain Rep. 2019 May 09;4(3):e747
pubmed: 31583360
Hum Psychopharmacol. 2013 Nov;28(6):544-51
pubmed: 24519690