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Malfliet A, De Baets L, Bilterys T, Van Looveren E, Mairesse O, Cagnie B, Meeus M, Moens M, Goubert D, Munneke W, Daneels L, Ickmans K, Kamper S, Nijs J. Cognitive Behavioral Therapy for Insomnia in Pain Management for Nonspecific Chronic Spinal Pain: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2425856. [PMID: 39120902 PMCID: PMC11316234 DOI: 10.1001/jamanetworkopen.2024.25856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024] Open
Abstract
Importance Insomnia is highly prevalent in patients with nonspecific chronic spinal pain (nCSP). Given the close interaction between insomnia and pain, targeting sleep problems during therapy could improve treatment outcomes. Objective To evaluate the effectiveness of cognitive behavioral therapy for insomnia (CBTi) integrated in best-evidence pain management (BEPM) vs BEPM only in patients with nCSP and insomnia. Design, Setting, and Participants A multicenter randomized clinical trial with 1-year follow-up was conducted between April 10, 2018, and April 30, 2022. Data and statistical analysis were performed between May 1, 2022, and April 24, 2023. Patients with nCSP and insomnia were evaluated using self-report and at-home polysomnography, to exclude underlying sleep pathologic factors. Participants were treated at the University Hospital Brussels or University Hospital Ghent, Belgium. Intention-to-treat analysis was performed. Interventions Participants were randomized to either CBTi-BEPM or BEPM only. Both groups received 18 treatment sessions over 14 weeks. The CBTi-BEPM treatment included 6 CBTi sessions and 12 BEPM sessions. The BEPM treatment included pain neuroscience education (3 sessions) and exercise therapy (9 sessions in the CBTi-BEPM group, 15 sessions in the BEPM-only group). Main Outcomes and Measures The primary outcome was change in mean pain intensity (assessed with Brief Pain Inventory [BPI]) at 12 months after the intervention. Exploratory secondary outcomes included several pain- and sleep-related outcomes. Blinded outcome assessment took place at baseline, posttreatment, and at 3-, 6-, and 12-month follow-up. Results A total of 123 patients (mean [SD] age, 40.2 [11.18] years; 84 women [68.3%]) were included in the trial. In 99 participants (80.5%) with 12-month BPI data, the mean pain intensity at 12 months decreased by 1.976 points (reduction of 40%) in the CBTi-BEPM group and 1.006 points (reduction of 24%) points in the BEPM-only group. At 12 months, there was no significant difference in pain intensity change between groups (mean group difference, 0.970 points; 95% CI, -0.051 to 1.992; Cohen d, 2.665). Treatment with CBTi-BEPM resulted in a response for BPI average pain with a number needed to treat (NNT) of 4 observed during 12 months. On a preliminary basis, CBTi-BEPM was, consistently over time and analyses, more effective than BEPM only for improving insomnia severity (Cohen d, 4.319-8.961; NNT for response ranging from 2 to 4, and NNT for remission ranging from 5 to 12), sleep quality (Cohen d, 3.654-6.066), beliefs about sleep (Cohen d, 5.324-6.657), depressive symptoms (Cohen d, 2.935-3.361), and physical fatigue (Cohen d, 2.818-3.770). No serious adverse effects were reported. Conclusions and Relevance In this randomized clinical trial, adding CBTi to BEPM did not further improve pain intensity reduction for patients with nCSP and comorbid insomnia more than BEPM alone. Yet, as CBTi-BEPM led to significant and clinically important changes in insomnia severity and sleep quality, CBTi integrated in BEPM should be considered in the treatment of patients with nCSP and comorbid insomnia. Further research can investigate the patient characteristics that moderate the response to CBTi-BEPM in terms of pain-related outcomes, as understanding of these moderators may be of utmost clinical importance. Trial Registration Clinical Trials.gov Identifier: NCT03482856.
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Affiliation(s)
- Anneleen Malfliet
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Research Foundation–Flanders, Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
| | - Liesbet De Baets
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
| | - Thomas Bilterys
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Eveline Van Looveren
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Olivier Mairesse
- Brain, Body and Cognition, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Pain in Motion International Research Consortium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Maarten Moens
- Pain in Motion International Research Consortium
- Department of Neurosurgery and Radiology, University Hospital Brussels, Brussels, Belgium
- Stimulus Research Group, Vrije Universiteit Brussels, Brussels, Belgium
- Center of Neurosciences, Vrije Universiteit Brussels, Brussels, Belgium
| | - Dorien Goubert
- Pain in Motion International Research Consortium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Wouter Munneke
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Lieven Daneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kelly Ickmans
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Movement & Nutrition for Health & Performance Research Group, Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - Steven Kamper
- School of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
- Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
| | - Jo Nijs
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Browne A, Cahalan R, O’ Sullivan K. How is cognitive behavioural therapy for insomnia delivered to adults with comorbid persistent musculoskeletal pain and disordered sleep? A scoping review. PLoS One 2024; 19:e0305931. [PMID: 39024361 PMCID: PMC11257322 DOI: 10.1371/journal.pone.0305931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Disordered sleep and persistent musculoskeletal pain are highly comorbid. Behavioural interventions such as Cognitive Behavioural Therapy for Insomnia (CBT-I) have shown promise in the management of both disordered sleep and persistent musculoskeletal pain. The aim of this review was to examine how CBT-I is delivered in randomised controlled trials involving people with comorbid disordered sleep and persistent musculoskeletal pain. METHODS The protocol for this scoping review was registered with the Open Science Framework. Electronic searches of ten database and three clinical trials registries were performed up to 25 October 2023. The methodological quality of each study was evaluated by two independent reviewers using the PEDro tool. The reporting of CBT-I interventions was evaluated using the Template for Intervention Description and Replication (TIDieR) checklist. RESULTS Twelve studies met the eligibility criteria. TIDieR scores ranged from 7-11/12, with a mean score of 8.8/12. CBT-I always involved two core components-sleep restriction and stimulus control. Furthermore, an additional five components were usually involved-a cognitive component, sleep hygiene, sleep education, relaxation/deactivation procedures and relapse planning. There was also considerable consistency in the frequency (weekly) and duration (5-9 weeks) of CBT-I programmes. Aspects inconsistently reported included who delivered the intervention; what modifications were made, if any; and the session content and duration. PEDro scores ranged from 5-8/10, with a mean score of 6.7/10. CONCLUSIONS These findings demonstrate considerable consistency in the components of CBT-I delivered in clinical trials along with the number of sessions. The frequency of sessions was also consistent where almost all studies held weekly session. However, some aspects were either not reported (e.g., precise content of components) or inconsistent (e.g., use of terminology). CBT-I was delivered both individually and in groups. Greater consistency, and more detailed reporting regarding who delivered the intervention, the training provided, and the specific content of CBT-I components would add clarity, and may enhance CBT-I efficacy and allow better replication.
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Affiliation(s)
- Abigail Browne
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Centre, University of Limerick, Limerick, Ireland
| | - Roisin Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Centre, University of Limerick, Limerick, Ireland
| | - Kieran O’ Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Sports and Human Performance Centre, University of Limerick, Limerick, Ireland
- Ageing Research Centre, University of Limerick, Limerick, Ireland
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3
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Pfeiffer AM, Triplett C, Siengsukon CF. Examining the prevalence of sleep disturbances in patients seeking physical therapy services. Physiother Theory Pract 2024; 40:556-564. [PMID: 36259637 DOI: 10.1080/09593985.2022.2134754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the prevalence of sleep disturbances in adults seeking physical therapy services. METHODS Participants were issued an electronic survey to provide demographic information and the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Sleep Hygiene Index (SHI), Insomnia Severity Index (ISI), STOP-BANG (obstructive sleep apnea (OSA) risk), and restless leg syndrome (RLS) risk. Percentages were calculated to describe prevalence of sleep disturbances, and Spearman's correlations were used to identify associations between pain and sleep questionnaires. RESULTS Eighty-eight participants (47.9 ± 15.8 years, 68 females) completed the survey. Seventy-eight percent (n = 69) scored >5 on the PSQI; 32% (n = 28) scored ≥10 on the ESS; 52% (n = 46) scored ≥16 on the SHI; 51% (n = 45) scored ≥10 on the ISI; 28% (n = 25) had intermediate or high risk of OSA; and 40% (n = 35) indicated possible RLS. Pain level was significantly associated with PSQI (r(86) = 0.277, p = .009) and ISI (r(86) = 0.268, p = .012). CONCLUSIONS There was a higher prevalence of sleep disturbances in adults seeking physical therapy services than in the general population. Increased pain severity was associated with poorer sleep quality and increased insomnia symptoms. This study highlights the need to screen patients for sleep disturbances.
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Affiliation(s)
- Ashley M Pfeiffer
- Department of Exercise Science, School of Behavioral Sciences, Black Hills State University, Spearfish, SD, USA
| | - Craig Triplett
- Department of Exercise Science, School of Behavioral Sciences, Black Hills State University, Spearfish, SD, USA
| | - Catherine F Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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Zambelli Z, Halstead EJ, Fidalgo AR, Mangar S, Dimitriou D. Telehealth delivery of adapted CBT-I for insomnia in chronic pain patients: a single arm feasibility study. Front Psychol 2024; 14:1266368. [PMID: 38274683 PMCID: PMC10808483 DOI: 10.3389/fpsyg.2023.1266368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Objectives 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. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Zoe Zambelli
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | - Elizabeth J. Halstead
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | | | - Stephen Mangar
- Department of Clinical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
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Catalá P, Gutiérrez L, Écija C, Peñacoba C. How to Generate Self-Efficacy despite Pain: The Role of Catastrophizing and Avoidance in Women with Fibromyalgia. Biomedicines 2023; 12:47. [PMID: 38255154 PMCID: PMC10812908 DOI: 10.3390/biomedicines12010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Fibromyalgia-related pain is influenced by numerous factors, including severity, as well as cognitive profiles based on pain catastrophizing or activity patterns. In this context, self-efficacy is identified as a potential predictor for explaining certain health outcomes. This study aimed to contribute to exploring the role of pain avoidance (as activity pattern) between pain severity and self-efficacy along pain catastrophizing. METHODS Through a cross-sectional study, a total of 264 women with fibromyalgia completed self-report measures of pain severity, pain avoidance, pain catastrophizing, and self-efficacy. The severity of the symptoms, the time elapsed since diagnosis, and the time elapsed since the onsets of symptoms were included as covariates to control. Regression-based moderated-mediation analysis was used to test the conditional effect of pain severity on self-efficacy via pain avoidance at varying levels of pain catastrophizing. RESULTS Pain avoidance mediated the effect of pain severity on self-efficacy. The indirect effects showed a moderated effect when patients scored high on the pain catastrophizing scale. The model evaluated, where catastrophic pain moderates the indirect effect of pain intensity on self-efficacy through pain avoidance, explained 49% of the variance. CONCLUSIONS Catastrophic beliefs associated with pain as being uncontrollable increase the relationship between pain severity and pain avoidance. In turn, pain avoidance is associated with a low perception of capacity.
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Affiliation(s)
| | | | | | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, 28922 Alcorcón, Madrid, Spain; (P.C.); (L.G.); (C.É.)
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Enomoto K, Adachi T, Fujino H, Kugo M, Tatsumi S, Sasaki J. Comparison of the effectiveness of cognitive behavioral therapy for insomnia, cognitive behavioral therapy for pain, and hybrid cognitive behavioral therapy for insomnia and pain in individuals with comorbid insomnia and chronic pain: A systematic review and network meta-analysis. Sleep Med Rev 2022; 66:101693. [PMID: 36410076 DOI: 10.1016/j.smrv.2022.101693] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 12/13/2022]
Abstract
Considering that insomnia and chronic pain are often comorbid, we aimed to compare the effectiveness of cognitive behavioral therapy for insomnia (CBT-I), cognitive behavioral therapy for pain (CBT-P), and cognitive behavioral therapy for insomnia and pain (CBT-IP) in individuals with comorbid insomnia and chronic pain. We used PubMed, PsycINFO, CENTRAL, and Web of Science for our literature search. The outcomes included sleep, pain, disability, and depression at post-treatment and follow-up (3-12 months). Sixteen randomized controlled trials with 1094 participants were included. In the Bayesian network meta-analysis, CBT-I [standard mean difference (SMD) = -0.99, 95% credible interval (CrI) = -1.50 to -0.54] and CBT-IP (SMD = -0.70, 95% CrI = -1.60 to -0.08) were significantly more effective than the control for sleep at post-treatment. Additionally, CBT-I was significantly more effective than the control for pain, disability, and depression at post-treatment and sleep at follow-up. However, there were no significant differences in effectiveness between CBT-P and the control for any outcomes. Thus, CBT-I might be the most effective treatment option for individuals with comorbid insomnia and chronic pain. However, given the small sample sizes and high risk of bias of the included studies, these results must be interpreted with caution.
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Affiliation(s)
- Kiyoka Enomoto
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan; Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan.
| | - Tomonori Adachi
- Graduate School of Human Development and Environment, Kobe University, Kobe, Hyogo, Japan
| | - Haruo Fujino
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan
| | - Masato Kugo
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Sakura Tatsumi
- FMCC Inc., Osaka, Japan; Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Jun Sasaki
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
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Salwen-Deremer JK, Sun M. Management of Sleep and Fatigue in Gastrointestinal Patients. Gastroenterol Clin North Am 2022; 51:829-847. [PMID: 36375999 DOI: 10.1016/j.gtc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Sleep is an essential physiologic process, and unfortunately, people with gastrointestinal (GI) conditions are more likely than people in the general population to experience poor sleep quality, sleep disorders, and fatigue. Herein, we present information on common sleep disorders, fatigue, and data on these problems in various GI populations. We also discuss several treatments for sleep concerns and emerging research on the use of these treatments in GI populations. Cases that illustrate the GI/sleep relationship are presented, in addition to guidance for your own practice and cultural considerations.
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Affiliation(s)
- Jessica K Salwen-Deremer
- Departments of Psychiatry and Medicine, Section of Gastroenterology & Hepatology, The Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Michael Sun
- Department of Psychological and Brain Sciences, Dartmouth College, 3 Maynard Street, Hanover, NH 03755, USA
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Kundakci B, Kaur J, Goh SL, Hall M, Doherty M, Zhang W, Abhishek A. Efficacy of nonpharmacological interventions for individual features of fibromyalgia: a systematic review and meta-analysis of randomised controlled trials. Pain 2022; 163:1432-1445. [PMID: 34813518 DOI: 10.1097/j.pain.0000000000002500] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Fibromyalgia is a highly heterogeneous condition, but the most common symptoms are widespread pain, fatigue, poor sleep, and low mood. Nonpharmacological interventions are recommended as first-line treatment of fibromyalgia. However which interventions are effective for the different symptoms is not well understood. The objective of this study was to assess the efficacy of nonpharmacological interventions on symptoms and disease-specific quality of life. Seven databases were searched from their inception until June 1, 2020. Randomised controlled trials comparing any nonpharmacological intervention to usual care, waiting list, or placebo in people with fibromyalgia aged >16 years were included without language restriction. Fibromyalgia Impact Questionnaire (FIQ) was the primary outcome measure. Standardised mean difference and 95% confidence interval were calculated using random effects model. The risk of bias was evaluated using the modified Cochrane tool. Of the 16,251 studies identified, 167 randomised controlled trials (n = 11,012) assessing 22 nonpharmacological interventions were included. Exercise, psychological treatments, multidisciplinary modality, balneotherapy, and massage improved FIQ. Subgroup analysis of different exercise interventions found that all forms of exercise improved pain (effect size [ES] -0.72 to -0.96) and depression (ES -0.35 to -1.22) except for flexibility exercise. Mind-body and strengthening exercises improved fatigue (ES -0.77 to -1.00), whereas aerobic and strengthening exercises improved sleep (ES -0.74 to -1.33). Psychological treatments including cognitive behavioural therapy and mindfulness improved FIQ, pain, sleep, and depression (ES -0.35 to -0.55) but not fatigue. The findings of this study suggest that nonpharmacological interventions for fibromyalgia should be individualised according to the predominant symptom.
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Affiliation(s)
- Burak Kundakci
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- cCentre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Jaspreet Kaur
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Siew Li Goh
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Michelle Hall
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Michael Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Weiya Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Abhishek Abhishek
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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Prados G, Miró E, Martínez MP, Sánchez AI, Pichot V, Medina-Casado M, Chouchou F. Effect of Cognitive-Behavioral Therapy on Nocturnal Autonomic Activity in Patients with Fibromyalgia: A Preliminary Study. Brain Sci 2022; 12:brainsci12070947. [PMID: 35884753 PMCID: PMC9320055 DOI: 10.3390/brainsci12070947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Objective: fibromyalgia is a complex chronic pain syndrome characterized by widespread musculoskeletal pain, insomnia and autonomic alterations. Cognitive-behavioral therapy (CBT) is regarded as a promising treatment in fibromyalgia, but its impact on autonomic function remains uncertain. In this research, we studied the effect of CBT on autonomic functions in fibromyalgia. Methods: Twenty-five participants underwent overnight polysomnographic recordings before and after CBT programs focused on pain (CBT-P) or a hybrid modality focused on pain and insomnia (CBT-C). Sleep quality, daily pain, depression and anxiety were assessed by self-reported questionnaires. We analyzed heart rate variability (HRV) using high-frequency power (HF) as a marker for parasympathetic activity, and low-frequency power (LF) and the LF/HF ratio as relative sympathetic markers during wakefulness and at each sleep stage. Results: After treatment, 14 patients (/25, 58.0%) reported improvement in their sleep: 6 in the CBT-P condition (/12, 50%), and 8 in the CBT-C condition (/13, 61.5%). We found that, regardless of the type of CBT, patients who reported improvement in sleep quality (n = 14, 58%) had an increase in HF during stages N2 (p < 0.05) and N3 (p < 0.05). These changes were related to improvement in sleep quality (N2, r = −0.43, p = 0.033) but not to pain, depression or anxiety. Conclusions: This study showed an improvement in parasympathetic cardiac control during non-rapid-eye-movement sleep following CBT in fibromyalgia participants who reported better sleep after this therapy. CBT may have a cardio-protective effect and HRV could be used as a sleep monitoring tool in fibromyalgia.
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Affiliation(s)
- Germán Prados
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Elena Miró
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18071 Granada, Spain; (M.P.M.); (A.I.S.)
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
- Correspondence: ; Tel.: +34-958249537
| | - M. Pilar Martínez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18071 Granada, Spain; (M.P.M.); (A.I.S.)
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
| | - Ana I. Sánchez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18071 Granada, Spain; (M.P.M.); (A.I.S.)
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
| | - Vincent Pichot
- INSERM, U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet, 42023 Saint-Etienne, France;
| | - Marta Medina-Casado
- Blood Transfusion Centre and Tissue Bank of Granada-Almería, 18014 Granada, Spain;
| | - Florian Chouchou
- IRISSE Laboratory (EA4075), UFR SHE, University of La Réunion, 97430 Le Tampon, France;
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Whale K, Gooberman‐Hill R. The importance of sleep for people with chronic pain: current insights and evidence. JBMR Plus 2022; 6:e10658. [PMID: 35866153 PMCID: PMC9289983 DOI: 10.1002/jbm4.10658] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/27/2022] Open
Abstract
We are currently in the midst of a sleep crisis. Our current work and lifestyle environments are normalizing poor sleep with substantial negative impact on our health. Research on sleep has linked sleep deprivation to poorer mental health, obesity, cancer, diabetes, heart disease, and a myriad of other health conditions. Sleep deprivation is an even greater issues for people with musculoskeletal conditions and chronic pain. Between 67% and 88% of individuals with chronic pain experience sleep disruption and insomnia, and at least 50% of people with insomnia report chronic pain. The link between sleep and pain is well documented. Experimental, cohort, and longitudinal studies have all demonstrated that restricted sleep is linked to greater pain. Poor sleep therefore not only affects general health but has a direct impact on inflammation, pain response, and experience. Improving sleep in people living with musculoskeletal conditions and with chronic pain has the potential to deliver great benefit to many. This article describes the evidence base that can underpin such work, including research about the link between pain and sleep as well as theories and approaches to intervention that may help. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Katie Whale
- Bristol Medical School University of Bristol
- National Institute for Health Research Bristol Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol UK
| | - Rachael Gooberman‐Hill
- Bristol Medical School University of Bristol
- National Institute for Health Research Bristol Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol UK
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11
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Whale K, Dennis J, Wylde V, Beswick A, Gooberman-Hill R. The effectiveness of non-pharmacological sleep interventions for people with chronic pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 2022; 23:440. [PMID: 35546397 PMCID: PMC9092772 DOI: 10.1186/s12891-022-05318-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/24/2022] [Indexed: 02/25/2023] Open
Abstract
Objective About two thirds of people with chronic pain report problems sleeping. We aimed to evaluate the effectiveness of non-pharmacological sleep interventions for improving sleep in people with chronic pain. Design We conducted a systematic review of non-pharmacological and non-invasive interventions to improve sleep quality or duration for adults with chronic non-cancer pain evaluated in a randomised controlled trial. Our primary outcome of interest was sleep; secondary outcomes included pain, health-related quality of life, and psychological wellbeing. We searched the Cochrane Library, MEDLINE, Embase, PsycINFO and CINAHL from inception to April 2020. After screening, two reviewers evaluated articles and extracted data. Meta-analysis was conducted using a random effects model. Risk of bias was assessed with the Cochrane tool. Results We included 42 trials involving 3346 people randomised to 94 groups, of which 56 received an intervention targeting sleep. 10 studies were of fair and 32 of good methodological quality. Overall risk of bias was judged to be low in 11, high in 10 and unclear in 21 studies. In 9 studies with 385 people randomised, cognitive behavioural therapy for insomnia showed benefit post-treatment compared with controls for improved sleep quality, standardised mean difference − 1.23 (95%CI -1.76, − 0.70; p < 0.00001). The effect size was only slightly reduced in meta-analysis of 3 studies at low risk of bias. The difference between groups was lower at 3 and 6 months after treatment but still favoured cognitive behavioural therapy for insomnia. Pain, anxiety and depression were reduced post-treatment, but evidence of longer term benefit was lacking. There was no evidence that sleep hygiene interventions were effective in improving sleep and there was some evidence in comparative studies to suggest that cognitive behavioural therapy for insomnia was more effective than sleep hygiene. Numerous other interventions were evaluated in small numbers of studies, but evidence was insufficient to draw conclusions about effectiveness. Conclusions Cognitive behavioural therapy for insomnia is an effective treatment to improve sleep for people with chronic pain, but further high-quality primary research is required to explore combined CBT content that will ensure additional improvements to pain, quality of life and psychological health and longer-term maintenance of benefits. Primary research is also needed to evaluate the effectiveness of interventions for which insufficient evidence exists. Trial registration PROSPERO registration number: CRD42019093799. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05318-5.
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Affiliation(s)
- Katie Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK. .,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
| | - Jane Dennis
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Andrew Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
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12
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Treatment of Insomnia within an Interdisciplinary Pain Rehabilitation Program: A Randomized Trial. Int J Clin Health Psychol 2022; 22:100295. [PMID: 35281773 PMCID: PMC8888978 DOI: 10.1016/j.ijchp.2022.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background/Objective Prior research indicates interdisciplinary pain rehabilitation program (IPRP) usual care (UC) does not sufficiently address sleep problems among individuals with comorbid chronic pain and clinical levels of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based insomnia intervention. The current study investigates the translation of CBT-I into an IPRP. Method In this single-site, prospective, randomized controlled pilot study, insomnia and pain-related outcomes were examined for adults participating in a 10-week IPRP (N = 79) who were allocated to a 4-session group-based CBT-I (IPRP+CBT-I) or usual care (IPRP-UC) condition. Results Patients in the IPRP+CBT-I group showed improvements in insomnia symptoms at the end compared to the beginning of the CBT-I group; however, there were no IPRP outcome differences relative to the IPRP-UC condition. Both groups reported statistically significant reductions in insomnia, pain severity, pain-related life interference, and depressed mood. Fewer than one-third of participants reported clinically meaningful reductions in insomnia symptoms following IPRP participation. Conclusions Further efforts are needed to address sleep problems in pain rehabilitation settings.
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13
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Collard VEJ, Moore C, Nichols V, Ellard DR, Patel S, Sandhu H, Parsons H, Sharma U, Underwood M, Madan J, Tang NKY. Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers. BMC FAMILY PRACTICE 2021; 22:210. [PMID: 34666682 PMCID: PMC8527665 DOI: 10.1186/s12875-021-01552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 08/30/2023]
Abstract
Background Chronic pain and insomnia have a complex, bidirectional relationship – addressing sleep complaints alongside pain may be key to alleviating patient-reported distress and disability. Healthcare professionals have consistently reported wanting to offer psychologically informed chronic pain management at the primary care level. Research in secondary care has demonstrated good treatment efficacy of hybrid CBT for chronic pain and insomnia. However, primary care is typically the main point of treatment entry, hence may be better situated to offer treatments using a multidisciplinary approach. In this study, primary care service providers’ perception of feasibility for tackling pain-related insomnia in primary care was explored. Methods The data corpus originates from a feasibility trial exploring hybrid CBT for chronic pain and insomnia delivered in primary care. This formed three in-depth group interviews with primary care staff (n = 9) from different primary care centres from the same NHS locale. All interviews were conducted on-site using a semi-structured approach. Verbal data was recorded, transcribed verbatim and analysed using the thematic analysis process. Results Eight themes were identified – 1) Discrepant conceptualisations of the chronic pain-insomnia relationship and clinical application, 2) Mismatch between patients’ needs and available treatment offerings, 3) Awareness of psychological complexities, 4) Identified treatment gap for pain-related insomnia, 5) Lack of funding and existing infrastructure for new service development, 6) General shortage of psychological services for complex health conditions, 7) Multidisciplinary team provision with pain specialist input, and 8) Accessibility through primary care. These mapped onto four domains - Current understanding and practice, Perceived facilitators, Perceived barriers, Ideal scenarios for a new treatment service – which reflected the focus of our investigation. Taken together these provide key context for understanding challenges faced by health care professionals in considering and developing a new clinical service. Conclusions Primary care service providers from one locale advocate better, multidisciplinary treatment provision for chronic pain and insomnia. Findings suggest that situating this in primary care could be a feasible option, but this requires systemic support and specialist input as well as definitive trials for success. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01552-3.
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Affiliation(s)
- V E J Collard
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - C Moore
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - V Nichols
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - D R Ellard
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - S Patel
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - H Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - H Parsons
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - U Sharma
- University/User Teaching and Research Action Partnership, University of Warwick, Coventry, CV4 7AL, UK
| | - M Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - J Madan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - N K Y Tang
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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14
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Ho FYY, Choi WT, Yeung WF, Lam HK, Lau WY, Chung KF. The efficacy of integrated cognitive behavioral therapy (CBT) and acupressure versus CBT for insomnia: a three-arm pilot randomized controlled trial. Sleep Med 2021; 87:158-167. [PMID: 34619500 DOI: 10.1016/j.sleep.2021.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This pilot study aimed to examine the efficacy of integrated cognitive behavioral therapy (CBT) and acupressure in treating insomnia and its daytime impairments in a Chinese adult population. METHODS 40 eligible participants with insomnia were randomly assigned to either the integrated CBT and acupressure (CBTAcup) group (n = 14), the CBT group (n = 13), or the waitlist control (WL) group (n = 13). Participants in the CBTAcup group attended a 2-hour integrated CBT and self-administered acupressure group treatment once per week for six consecutive weeks, while participants in the CBT group attended six weekly 2-hour CBT for insomnia. Sleep, mood, daytime impairments, quality of life, and treatment credibility and adherence were assessed at baseline, immediate post-treatment (Week 7), and 4-week post-treatment (Week 11). RESULTS Linear mixed-effects models showed that both the CBTAcup and CBT groups had significantly lower insomnia severity (d = -1.74 and d = -2.61), dysfunctional beliefs related to sleep (d = -2.17 and -2.76), and mental fatigue (d = -1.43 and -1.60) compared with the WL group at Week 7. The CBTAcup group provided additional benefits in reducing total fatigue (d = -1.43) and physical fatigue (d = -1.45). Treatment credibility was found to be improved in the CBTAcup group from baseline to Week 7. CONCLUSIONS Integrated CBT and acupressure demonstrated comparable efficacy to pure CBT in treating insomnia symptoms, with additional advantages to improve fatigue symptoms and acceptability in the Chinese population. Further methodologically rigorous studies on a larger scale and longer follow-up are warranted to confirm these findings.
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Affiliation(s)
- Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Wing-Ting Choi
- Department of Clinical Psychology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hunghom, Hong Kong
| | - Hiu-Kwan Lam
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing-Yin Lau
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka-Fai Chung
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong
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15
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Tang NKY. Is cognitive-behaviour therapy for insomnia (CBT-I) the new best pain killer? Sleep Med Rev 2021; 60:101536. [PMID: 34416427 DOI: 10.1016/j.smrv.2021.101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK.
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16
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Climent-Sanz C, Valenzuela-Pascual F, Martínez-Navarro O, Blanco-Blanco J, Rubí-Carnacea F, García-Martínez E, Soler-González J, Barallat-Gimeno E, Gea-Sánchez M. Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis. Disabil Rehabil 2021; 44:5770-5783. [PMID: 34297651 DOI: 10.1080/09638288.2021.1954706] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to evaluate the effectiveness of CBT-i in patients with fibromyalgia in comparison with other non-pharmacological treatments. METHODS Randomized controlled trials assessing the effects of CBT-i in adults with fibromyalgia, published in English or Spanish, were eligible. Electronic searches were performed using PubMed, Scopus, The Cochrane Library, WebOfKnowledge and Psicodoc databases in March 2021. The main outcome measures were sleep efficiency and sleep quality. Secondary outcomes included pain, depression, and anxiety. RESULTS Of 226 studies reviewed, five were included in the meta-analysis. CBT-i compared with non-pharmacological treatments showed no significant improvements in sleep efficiency (p = 0.05; standardized mean difference (SMD) [95% CI] 0.31 [-0.00 to 0.61]). CBT-i showed significant improvements in sleep quality (p = 0.009; SMD [95% CI] - 0.53 [-0.93 to -0.13]), pain (p = 0.002; SMD [95% CI] - 0.41 [-0.67 to -0.16]), anxiety (p = 0.001; SMD [95% CI] - 0.46 [-0.74 to 0.18]) and depression (p = 0.02; SMD [95% CI] - 0.33 [-0.61 to -0.05]), compared to non-pharmacological treatments. Effect sizes ranged from small to moderate. CONCLUSIONS CBT-i was associated with a significant improvement in sleep quality, pain, anxiety, and depression, although these results are retrieved from very few studies with only very low to low quality evidence. Trial registration: The review protocol was registered with PROSPERO (Record ID = CRD42016030161).IMPLICATIONS FOR REHABILITATIONCBT-i has been proven to improve sleep quality, pain, anxiety and depression, although with small effect sizes.Implementing hybrid CBT for pain and sleep or combining CBT and mindfulness may improve symptoms in people diagnosed with FM.This meta-analysis results highlight the need to enhance sleep management skills among people suffering from this health condition.
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Affiliation(s)
- Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Fran Valenzuela-Pascual
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | | | - Joan Blanco-Blanco
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Francesc Rubí-Carnacea
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Ester García-Martínez
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Jorge Soler-González
- Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Faculty of Medicine, University of Lleida, Lleida, Spain.,Catalan Health Institute, Lleida, Spain
| | - Eva Barallat-Gimeno
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
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17
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Whibley D, Stelfox K, Henry AL, Tang NKY, Kratz AL. Development of a hybrid sleep and physical activity improvement intervention for adults with osteoarthritis-related pain and sleep disturbance: a focus group study with potential users. Br J Pain 2021; 16:136-148. [PMID: 35419203 PMCID: PMC8998527 DOI: 10.1177/20494637211026049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Suboptimal sleep and physical activity are common among people living with osteoarthritis (OA) and simultaneous improvements in both may have a beneficial impact on pain. This study aimed to gather perspectives of people living with OA on important aspects to incorporate in a hybrid sleep and physical activity improvement intervention for OA pain management. Design: Qualitative study using two rounds of two focus groups. Setting and participants: Focus groups were conducted with adults living with OA-related chronic pain and sleep disturbances. Eighteen people attended focus groups in January 2020 and, of these, 16 attended subsequent focus groups in February 2020. Methods: Discussion at the first round of focus groups informed generation of prototype intervention materials that were shared, discussed and refined at the second round of focus groups. Thematic analysis was used to identify themes and sub-themes from the data. Results: Three themes, each with three sub-themes, were identified: facilitators of engagement with the intervention (sub-themes: motivational language, accountability and education); barriers to engagement (sub-themes: suboptimal interaction with healthcare practitioners, recording behaviour as burdensome/disruptive and uncertainty about technique) and characteristics of a physical activity intervention component (sub-themes: tailored, sustainable and supported). Conclusion: We have identified important aspects to incorporate into the design and delivery of a hybrid sleep and physical activity improvement intervention for OA pain management. Insights will be incorporated into intervention materials and protocols, with feasibility and acceptability assessed in a future study.
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Affiliation(s)
- Daniel Whibley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Stelfox
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- School of Education, University of Aberdeen, Aberdeen, UK
| | - Alasdair L Henry
- Big Health Inc., San Francisco, CA, USA
- Big Health Inc., London, UK
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Nicole KY Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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18
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Sipilä RM, Kalso EA. Sleep Well and Recover Faster with Less Pain-A Narrative Review on Sleep in the Perioperative Period. J Clin Med 2021; 10:jcm10092000. [PMID: 34066965 PMCID: PMC8124518 DOI: 10.3390/jcm10092000] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 01/02/2023] Open
Abstract
Sleep disturbance, pain, and having a surgical procedure of some kind are all very likely to occur during the average lifespan. Postoperative pain continues to be a prevalent problem and growing evidence supports the association between pain and sleep disturbances. The bidirectional nature of sleep and pain is widely acknowledged. A decline in sleep quality adds a risk for the onset of pain and also exacerbates existing pain. The risk factors for developing insomnia and experiencing severe pain after surgery are quite similar. The main aim of this narrative review is to discuss why it is important to be aware of sleep disturbances both before and after surgery, to know how sleep disturbances should be assessed and monitored, and to understand how better sleep can be supported by both pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Reetta M. Sipilä
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland;
- Sleep Well Research Programme, University of Helsinki, 00016 Helsinki, Finland
- Correspondence:
| | - Eija A. Kalso
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland;
- Sleep Well Research Programme, University of Helsinki, 00016 Helsinki, Finland
- Department of Pharmacology, University of Helsinki, 00016 Helsinki, Finland
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19
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García-Dasí M, Pérez-Alenda S, Carrasco JJ, Marques-Sule E, Aguilar-Rodríguez M, Moreno-Segura N, Gómez-Tomás C, Querol F, Bonanad S. Effects of a non-pharmacological approach for chronic pain management in patients with haemophilia: efficacy of cognitive-behavioural therapy associated with physiotherapy. Haemophilia 2021; 27:e357-e367. [PMID: 33650767 DOI: 10.1111/hae.14284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION More than half of adult patients with severe haemophilia (PWH) suffer pain daily, with chronic pain (CP) in more than 15% of cases, thereby reducing their quality of life (QoL). However, there are no evidence-based therapeutic guidelines for pain management. AIM To evaluate the effectiveness of a combined protocol based on psychology and physiotherapy in the improvement of CP self-efficacy in PWH with CP. Secondary outcomes are changes in QoL, emotional status, pain and kinesiophobia. METHODS In this prospective controlled trial study, recruited patients were allocated either to an experimental group (EG, n = 10) or to a control group (CG, n = 9). EG received interventions over four months: one cognitive-behavioural therapy (CBT) session per month and three home exercise sessions per week. Self-efficacy (Chronic Pain Self-Efficacy Scale), QoL (A36 Hemophilia-QoL), emotional status (Hospital Anxiety and Depression Scale and Rosenberg's Self-esteem Scale), pain (Visual Analogue Scale) and kinesiophobia (Tampa Scale for Kinesiophobia) were assessed at three time points (Week 0, Month 4 and Month 7). The intervention effects were determined with mixed 2-factor ANOVAs. RESULTS The EG showed a significant improvement (p < .05) in the control of symptoms and pain management scores on the Self-Efficacy Scale, QoL, self-esteem emotional status, pain and kinesiophobia. The intervention effects remained significant (p < .05) over time for pain management, QoL, pain and kinesiophobia. CONCLUSION The non-pharmacological treatment applied based on CBT and physiotherapy showed to be effective in improving CP self-efficacy, QoL and emotional status, while reducing pain and kinesiophobia in PWH with CP.
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Affiliation(s)
- María García-Dasí
- Instituto de Investigaciones Sanitarias La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain.,Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Sofía Pérez-Alenda
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.,Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.,Research unit in Clinical biomechanics (UBIC), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Cinta Gómez-Tomás
- Grupo de Investigación en Fisioterapia y Readaptación al Deporte, Universidad Católica San Antonio de Murcia, Murcia, España
| | - Felipe Querol
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.,Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
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Selvanathan J, Pham C, Nagappa M, Peng PWH, Englesakis M, Espie CA, Morin CM, Chung F. Cognitive behavioral therapy for insomnia in patients with chronic pain - A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2021; 60:101460. [PMID: 33610967 DOI: 10.1016/j.smrv.2021.101460] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Janannii Selvanathan
- 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
| | - Chi Pham
- 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
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Western University, London, ON, Canada
| | - Philip W H Peng
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Canada
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, Oxfordshire, UK
| | - Charles M Morin
- Department of Psychology, Laval University, Québec, QC, Canada
| | - Frances Chung
- 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.
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21
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Mascarenhas RO, Souza MB, Oliveira MX, Lacerda AC, Mendonça VA, Henschke N, Oliveira VC. Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis. JAMA Intern Med 2021; 181:104-112. [PMID: 33104162 PMCID: PMC7589080 DOI: 10.1001/jamainternmed.2020.5651] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Fibromyalgia is a chronic condition that results in a significant burden to individuals and society. OBJECTIVE To investigate the effectiveness of therapies for reducing pain and improving quality of life (QOL) in people with fibromyalgia. DATA SOURCES Searches were performed in the MEDLINE, Cochrane, Embase, AMED, PsycInfo, and PEDro databases without language or date restrictions on December 11, 2018, and updated on July 15, 2020. STUDY SELECTION All published randomized or quasi-randomized clinical trials that investigated therapies for individuals with fibromyalgia were screened for inclusion. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias using the 0 to 10 PEDro scale. Effect sizes for specific therapies were pooled using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. MAIN OUTCOMES AND MEASURES Pain intensity measured by the visual analog scale, numerical rating scales, and other valid instruments and QOL measured by the Fibromyalgia Impact Questionnaire. RESULTS A total of 224 trials including 29 962 participants were included. High-quality evidence was found in favor of cognitive behavioral therapy (weighted mean difference [WMD], -0.9; 95% CI, -1.4 to -0.3) for pain in the short term and was found in favor of central nervous system depressants (WMD, -1.2 [95% CI, -1.6 to -0.8]) and antidepressants (WMD, -0.5 [95% CI, -0.7 to -0.4]) for pain in the medium term. There was also high-quality evidence in favor of antidepressants (WMD, -6.8 [95% CI, -8.5 to -5.2]) for QOL in the short term and in favor of central nervous system depressants (WMD, -8.7 [95% CI, -11.3 to -6.0]) and antidepressants (WMD, -3.5 [95% CI, -4.5 to -2.5]) in the medium term. However, these associations were small and did not exceed the minimum clinically important change (2 points on an 11-point scale for pain and 14 points on a 101-point scale for QOL). Evidence for long-term outcomes of interventions was lacking. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis suggests that most of the currently available therapies for the management of fibromyalgia are not supported by high-quality evidence. Some therapies may reduce pain and improve QOL in the short to medium term, although the effect size of the associations might not be clinically important to patients.
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Affiliation(s)
| | - Mateus Bastos Souza
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Murilo Xavier Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Ana Cristina Lacerda
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Vanessa Amaral Mendonça
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Vinícius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
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Williams ACDC, Fisher E, Hearn L, Eccleston C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2020; 8:CD007407. [PMID: 32794606 PMCID: PMC7437545 DOI: 10.1002/14651858.cd007407.pub4] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic non-cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012. OBJECTIVES To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) compared with active controls, or waiting list/treatment as usual (TAU). SEARCH METHODS We identified randomised controlled trials (RCTs) of psychological therapies by searching CENTRAL, MEDLINE, Embase and PsycINFO to 16 April 2020. We also examined reference lists and trial registries, and searched for studies citing retrieved trials. SELECTION CRITERIA RCTs of psychological treatments compared with active control or TAU of face-to-face therapies for adults with chronic pain. We excluded studies of headache or malignant disease, and those with fewer than 20 participants in any arm at treatment end. DATA COLLECTION AND ANALYSIS Two or more authors rated risk of bias, extracted data, and judged quality of evidence (GRADE). We compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or TAU at treatment end, and at six month to 12 month follow-up. We did not analyse the few trials of other psychological treatments. We assessed treatment effectiveness for pain intensity, disability, and distress. We extracted data on adverse events (AEs) associated with treatment. MAIN RESULTS We added 41 studies (6255 participants) to 34 of the previous review's 42 studies, and now have 75 studies in total (9401 participants at treatment end). Most participants had fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. Most risk of bias domains were at high or unclear risk of bias, with selective reporting and treatment expectations mostly at unclear risk of bias. AEs were inadequately recorded and/or reported across studies. CBT The largest evidence base was for CBT (59 studies). CBT versus active control showed very small benefit at treatment end for pain (standardised mean difference (SMD) -0.09, 95% confidence interval (CI) -0.17 to -0.01; 3235 participants; 23 studies; moderate-quality evidence), disability (SMD -0.12, 95% CI -0.20 to -0.04; 2543 participants; 19 studies; moderate-quality evidence), and distress (SMD -0.09, 95% CI -0.18 to -0.00; 3297 participants; 24 studies; moderate-quality evidence). We found small benefits for CBT over TAU at treatment end for pain (SMD -0.22, 95% CI -0.33 to -0.10; 2572 participants; 29 studies; moderate-quality evidence), disability (SMD -0.32, 95% CI -0.45 to -0.19; 2524 participants; 28 studies; low-quality evidence), and distress (SMD -0.34, 95% CI -0.44 to -0.24; 2559 participants; 27 studies; moderate-quality evidence). Effects were largely maintained at follow-up for CBT versus TAU, but not for CBT versus active control. Evidence quality for CBT outcomes ranged from moderate to low. We rated evidence for AEs as very low quality for both comparisons. BT We analysed eight studies (647 participants). We found no evidence of difference between BT and active control at treatment end (pain SMD -0.67, 95% CI -2.54 to 1.20, very low-quality evidence; disability SMD -0.65, 95% CI -1.85 to 0.54, very low-quality evidence; or distress SMD -0.73, 95% CI -1.47 to 0.01, very low-quality evidence). At follow-up, effects were similar. We found no evidence of difference between BT and TAU (pain SMD -0.08, 95% CI -0.33 to 0.17, low-quality evidence; disability SMD -0.02, 95% CI -0.24 to 0.19, moderate-quality evidence; distress SMD 0.22, 95% CI -0.10 to 0.54, low-quality evidence) at treatment end. At follow-up, we found one to three studies with no evidence of difference between BT and TAU. We rated evidence for all BT versus active control outcomes as very low quality; for BT versus TAU. Evidence quality ranged from moderate to very low. We rated evidence for AEs as very low quality for BT versus active control. No studies of BT versus TAU reported AEs. ACT We analysed five studies (443 participants). There was no evidence of difference between ACT and active control for pain (SMD -0.54, 95% CI -1.20 to 0.11, very low-quality evidence), disability (SMD -1.51, 95% CI -3.05 to 0.03, very low-quality evidence) or distress (SMD -0.61, 95% CI -1.30 to 0.07, very low-quality evidence) at treatment end. At follow-up, there was no evidence of effect for pain or distress (both very low-quality evidence), but two studies showed a large benefit for reducing disability (SMD -2.56, 95% CI -4.22 to -0.89, very low-quality evidence). Two studies compared ACT to TAU at treatment end. Results should be interpreted with caution. We found large benefits of ACT for pain (SMD -0.83, 95% CI -1.57 to -0.09, very low-quality evidence), but none for disability (SMD -1.39, 95% CI -3.20 to 0.41, very low-quality evidence), or distress (SMD -1.16, 95% CI -2.51 to 0.20, very low-quality evidence). Lack of data precluded analysis at follow-up. We rated evidence quality for AEs to be very low. We encourage caution when interpreting very low-quality evidence because the estimates are uncertain and could be easily overturned. AUTHORS' CONCLUSIONS We found sufficient evidence across a large evidence base (59 studies, over 5000 participants) that CBT has small or very small beneficial effects for reducing pain, disability, and distress in chronic pain, but we found insufficient evidence to assess AEs. Quality of evidence for CBT was mostly moderate, except for disability, which we rated as low quality. Further trials may provide more precise estimates of treatment effects, but to inform improvements, research should explore sources of variation in treatment effects. Evidence from trials of BT and ACT was of moderate to very low quality, so we are very uncertain about benefits or lack of benefits of these treatments for adults with chronic pain; other treatments were not analysed. These conclusions are similar to our 2012 review, apart from the separate analysis of ACT.
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Affiliation(s)
- Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
- Centre for Pain Research, University of Bath, Bath, UK
| | - Leslie Hearn
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
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23
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Salwen-Deremer JK, Siegel CA, Smith MT. Cognitive Behavioral Therapy for Insomnia: A Promising Treatment for Insomnia, Pain, and Depression in Patients With IBD. CROHN'S & COLITIS 360 2020; 2:otaa052. [PMID: 36776493 PMCID: PMC9802437 DOI: 10.1093/crocol/otaa052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Indexed: 12/18/2022] Open
Abstract
Over 75% of people with active inflammatory bowel diseases (IBDs) report sleep disturbances, which heighten risk for IBD relapse and flares. Despite mounting evidence for sleep disturbances in IBD, discussion of treatment is severely limited. The most common sleep disturbance, insomnia, occurs in over 50% of adults with chronic health conditions. Herein we describe the gold standard treatment for insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I). Although yet to be studied in IBD, CBT-I reduces a number of IBD-related comorbidities, including chronic pain, depression, and systemic inflammation. We describe treatment with CBT-I, the impact of CBT-I on these comorbidities, and recommendations for providers.
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Affiliation(s)
- Jessica K Salwen-Deremer
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA,Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA,Address correspondence to: Jessica K. Salwen-Deremer, PhD, One Medical Center Drive, Lebanon, NH 03756 ()
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Michael T Smith
- Department of Psychiatry, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Nursing, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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24
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Prados G, Miró E, Martínez MP, Sánchez AI, Lami MJ, Cáliz R. Combined cognitive-behavioral therapy for fibromyalgia: Effects on polysomnographic parameters and perceived sleep quality. Int J Clin Health Psychol 2020; 20:232-242. [PMID: 32994796 PMCID: PMC7501455 DOI: 10.1016/j.ijchp.2020.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Objective: Cognitive-behavioral therapy (CBT) is one of the first-line treatments in the management of fibromyalgia (FM) and it has been applied with considerable success to treat the psychological processes associated with pain and insomnia. We hypothesized that treating sleep and pain jointly with new combined modalities of CBT may offer greater sleep-related benefits to patients. Method: Thirty-nine female patients with FM and insomnia were randomly allocated to receive CBT centered on pain (CBT-P) or combined CBT focused on pain and insomnia (CBT-C). Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index and an ambulatory polysomnography.Results: Participants who received CBT-P showed increases in time in bed and total sleep time and decreases in light sleep, but there was no improvement in perceived sleep quality. Participants who received combined CBT-C showed more meaningful improvements related to refreshing sleep (i.e., higher sleep efficiency and less time awake and longer time in Stage 4 sleep), and these changes were concordant with a significant improvement in self-perceived sleep quality. Conclusions: This study suggests that new CBT-C approaches can improve insomnia-related clinical aspects.
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Affiliation(s)
- Germán Prados
- Department of Nursing, Health Science Faculty, University of Granada, Spain
- Corresponding author. Departamento de Enfermería, Facultad de Ciencias de la Salud, Avenida de la Ilustración, 60, 18071, Granada, España.
| | - Elena Miró
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
- Mind, Brain and Behavior Research Center, University of Granada, Spain
| | - M. Pilar Martínez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
- Mind, Brain and Behavior Research Center, University of Granada, Spain
| | - Ana. I. Sánchez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
- Mind, Brain and Behavior Research Center, University of Granada, Spain
| | - M. José Lami
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - Rafael Cáliz
- Rheumatology Service, Virgen de las Nieves University Hospital, Granada, Spain
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25
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Climent-Sanz C, Marco-Mitjavila A, Pastells-Peiró R, Valenzuela-Pascual F, Blanco-Blanco J, Gea-Sánchez M. Patient Reported Outcome Measures of Sleep Quality in Fibromyalgia: A COSMIN Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2992. [PMID: 32357398 PMCID: PMC7246509 DOI: 10.3390/ijerph17092992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022]
Abstract
Poor sleep quality is a common concern and a troublesome symptom among patients suffering from fibromyalgia. The purpose of this review was to identify and describe the available patient reported outcome measures (PROMs) of sleep quality validated in adult people diagnosed with fibromyalgia. The COSMIN and PRISMA recommendations were followed. An electronic systematized search in the electronic databases PubMed, Scopus, CINAHL Plus, PsycINFO, and ISI Web of Science was carried out. Validation studies of PROMs of sleep quality in fibromyalgia published in English or Spanish were included. The selection of the studies was developed through a peer review process through the online software "COVIDENCE". The quality of the studies was assessed using the COSMIN Risk of Bias checklist. A total of 5 PROMs were found validated in patients with fibromyalgia: (1) Pittsburgh Sleep Quality Index (PSQI), (2) Jenkins Sleep Scale (JSS), (3) Sleep Quality Numeric Rating Scale (SQ-NRS), (4) Medical Outcomes Study-Sleep Scale (MOS-SS), and (5) Fibromyalgia Sleep Diary (FSD). The quality of the evidence was very good and the quality of the results ranged from moderate to high. All the included PROMs, except for the FSD, showed adequate psychometric properties and, therefore, are valid and reliable tools for assessing sleep quality in the context of FM. However, none of the studies analyzed all the psychometric properties of the included PROMs as established in the COSMIN guidelines, highlighting that this is a potential field of research for future investigations.
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Affiliation(s)
- Carolina Climent-Sanz
- Faculty of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (A.M.-M.); (R.P.-P.); (F.V.-P.); (M.G.-S.)
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, 25001 Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica de Lleida, IRB, 25198 Lleida, Spain
| | - Anna Marco-Mitjavila
- Faculty of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (A.M.-M.); (R.P.-P.); (F.V.-P.); (M.G.-S.)
| | - Roland Pastells-Peiró
- Faculty of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (A.M.-M.); (R.P.-P.); (F.V.-P.); (M.G.-S.)
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, 25001 Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica de Lleida, IRB, 25198 Lleida, Spain
| | - Fran Valenzuela-Pascual
- Faculty of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (A.M.-M.); (R.P.-P.); (F.V.-P.); (M.G.-S.)
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, 25001 Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica de Lleida, IRB, 25198 Lleida, Spain
| | - Joan Blanco-Blanco
- Faculty of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (A.M.-M.); (R.P.-P.); (F.V.-P.); (M.G.-S.)
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, 25001 Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica de Lleida, IRB, 25198 Lleida, Spain
| | - Montserrat Gea-Sánchez
- Faculty of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (A.M.-M.); (R.P.-P.); (F.V.-P.); (M.G.-S.)
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, 25001 Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica de Lleida, IRB, 25198 Lleida, Spain
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26
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McCrae CS, Curtis AF, Miller MB, Nair N, Rathinakumar H, Davenport M, Berry JR, McGovney K, Staud R, Berry R, Robinson M. Effect of cognitive behavioural therapy on sleep and opioid medication use in adults with fibromyalgia and insomnia. J Sleep Res 2020; 29:e13020. [PMID: 32126156 DOI: 10.1111/jsr.13020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 01/24/2023]
Abstract
Sleep and opioid medications used to treat insomnia and chronic pain are associated with adverse side effects (falls and cognitive disturbance). Although behavioural treatments such as cognitive behavioral therapy for insomnia (CBT-I) and pain (CBT-P) improve sleep and clinical pain, their effects on sleep and opioid medication use are unclear. In this secondary analysis of published trial data, we investigated whether CBT-I and CBT-P reduced reliance on sleep/opioid medication in patients with fibromyalgia and insomnia (FMI). Patients with FMI (n = 113, Mage = 53.0, SD = 10.9) completed 8 weeks of CBT-I (n = 39), CBT-P (n = 37) or waitlist control (WLC; n = 37). Participants completed 14 daily diaries at baseline, post-treatment and 6-month follow-up, assessing sleep and opioid medication usage. Multilevel modelling examined group by time effects on days of medication use. A significant interaction revealed CBT-P reduced the number of days of sleep medication use at post-treatment, but usage returned to baseline levels at follow-up. There were no other significant within- or between-group effects. CBT-P led to immediate reductions in sleep medication usage, despite lack of explicit content regarding sleep medication. CBT-I and CBT-P may be ineffective as stand-alone treatments for altering opioid use in FMI. Future work should explore CBT as an adjunct to other behavioural techniques for opioid reduction.
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Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri, Columbia, Missouri, United States
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri, Columbia, Missouri, United States.,Department of Psychological Sciences, University of Missouri, Columbia, Missouri, United States
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, Missouri, United States
| | - Neetu Nair
- Department of Psychiatry, University of Missouri, Columbia, Missouri, United States
| | | | - Mattina Davenport
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, United States
| | - Jasmine R Berry
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, United States
| | - Kevin McGovney
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, United States
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Richard Berry
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Michael Robinson
- Department of Clinical Health Psychology, University of Florida, Gainesville, Florida, United States
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27
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Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:237-261. [PMID: 32002933 DOI: 10.1007/978-981-32-9705-0_15] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Natalie Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Andres Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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28
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Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology 2020; 45:205-216. [PMID: 31207606 PMCID: PMC6879497 DOI: 10.1038/s41386-019-0439-z] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 11/09/2022]
Abstract
Pain can be both a cause and a consequence of sleep deficiency. This bidirectional relationship between sleep and pain has important implications for clinical management of patients, but also for chronic pain prevention and public health more broadly. The review that follows will provide an overview of the neurobiological evidence of mechanisms thought to be involved in the modulation of pain by sleep deficiency, including the opioid, monoaminergic, orexinergic, immune, melatonin, and endocannabinoid systems; the hypothalamus-pituitary-adrenal axis; and adenosine and nitric oxide signaling. In addition, it will provide a broad overview of pharmacological and non-pharmacological approaches for the management of chronic pain comorbid with sleep disturbances and for the management of postoperative pain, as well as discuss the effects of sleep-disturbing medications on pain amplification.
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Dudeney J, Law EF, Meyyappan A, Palermo TM, Rabbitts JA. Evaluating the psychometric properties of the Widespread Pain Index and the Symptom Severity scale in youth with painful conditions. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2019; 3:137-147. [PMID: 32051925 PMCID: PMC7015535 DOI: 10.1080/24740527.2019.1620097] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Assessing features of centralized pain may prove to be clinically meaningful in pediatric populations. However, we are currently limited by the lack of validated pediatric measures. Aim We examined the psychometric properties of the Widespread Pain Index (WPI) and Symptom Severity (SS) scale, to assess features of centralized pain, in youth with painful conditions from three clinical samples: (1) musculoskeletal surgery, (2) headache, and (3) chronic pain. Methods Participants were 240 youth aged 10-18 years (Mage=14.8, SD=1.9) who completed the WPI and SS scale. Subsets of participants also completed additional measures of pain region, pain intensity, quality of life, pain interference and physical function. Results Increased features of centralized pain by age were seen for the WPI (r=0.27, p<0.01) and SS scale (r=0.29, p<0.01). Expected differences in sex were seen for the WPI (sex:t132=-3.62, p<0.01), but not the SS scale (sex:t223=-1.73, p=0.09). Reliability for the SS scale was adequate (α=.70). Construct validity was demonstrated through relationships between the WPI and pain regions (r=.57, p<0.01), and between the SS scale and quality of life (r=-.59, p<0.01) and pain interference (r=.56, p<0.01). Criterion validity was demonstrated by differences on the WPI between the surgery sample and the headache and chronic pain samples (F2,237=17.55, p<0.001). Comprehension of the SS scale items was problematic for some youth. Conclusions The WPI showed adequate psychometric properties in youth; however the SS scale may need to be modified. Our findings support the need to develop psychometrically sound instruments for comprehensive assessment of pain in pediatric samples.
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Affiliation(s)
- Joanne Dudeney
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Emily F Law
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Alagumeena Meyyappan
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer A Rabbitts
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
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McCrae CS, Williams J, Roditi D, Anderson R, Mundt JM, Miller MB, Curtis AF, Waxenberg LB, Staud R, Berry RB, Robinson ME. Cognitive behavioral treatments for insomnia and pain in adults with comorbid chronic insomnia and fibromyalgia: clinical outcomes from the SPIN randomized controlled trial. Sleep 2019; 42:zsy234. [PMID: 30496533 PMCID: PMC6424087 DOI: 10.1093/sleep/zsy234] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 10/25/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To examine the effects of cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in patients with comorbid fibromyalgia and insomnia. METHODS One hundred thirteen patients (Mage = 53, SD = 10.9) were randomized to eight sessions of CBT-I (n = 39), CBT-P (n = 37), or a waitlist control (WLC, n = 37). Primary (self-reported sleep onset latency [SOL], wake after sleep onset [WASO], sleep efficiency [SE], sleep quality [SQ], and pain ratings) and secondary outcomes (dysfunctional beliefs and attitudes about sleep [DBAS]; actigraphy and polysomnography SOL, WASO, and SE; McGill Pain Questionnaire; Pain Disability Index; depression; and anxiety) were examined at posttreatment and 6 months. RESULTS Mixed effects analyses revealed that both treatments improved self-reported WASO, SE, and SQ relative to control at posttreatment and follow-up, with generally larger effect sizes for CBT-I. DBAS improved in CBT-I only. Pain and mood improvements did not differ by group. Clinical significance analyses revealed the proportion of participants no longer reporting difficulties initiating and maintaining sleep was higher for CBT-I posttreatment and for both treatments at 6 months relative to control. Few participants achieved >50% pain reductions. Proportion achieving pain reductions of >30% (~1/3) was higher for both treatments posttreatment and for CBT-I at 6 months relative to control. CONCLUSIONS CBT-I and CBT-P improved self-reported insomnia symptoms. CBT-I prompted improvements of larger magnitude that were maintained. Neither treatment improved pain or mood. However, both prompted clinically meaningful, immediate pain reductions in one third of patients. Improvements persisted for CBT-I, suggesting that CBT-I may provide better long-term pain reduction than CBT-P. Research identifying which patients benefit and mechanisms driving intervention effects is needed. CLINICAL TRIAL Sleep and Pain Interventions in Fibromyalgia (SPIN), clinicaltrials.gov, NCT02001077.
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Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri – Columbia, Columbia, MO
| | - Jacob Williams
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Daniela Roditi
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Ryan Anderson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Jennifer M Mundt
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri – Columbia, Columbia, MO
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri – Columbia, Columbia, MO
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Roland Staud
- Department of Rheumatology and Clinical Immunology, University of Florida, Gainesville, FL
| | - Richard B Berry
- Division of Pulmonary, Critical Care and Sleep Medicine, Gainesville, FL
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
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Koffel E, McCurry SM, Smith MT, Vitiello MV. Improving pain and sleep in middle-aged and older adults: the promise of behavioral sleep interventions. Pain 2019; 160:529-534. [PMID: 30562269 PMCID: PMC6377323 DOI: 10.1097/j.pain.0000000000001423] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Erin Koffel
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA
- University of Minnesota Medical School, F282/2A West Building, 2450 Riverside Avenue South, Minneapolis, MN 55454, USA
| | - Susan M. McCurry
- Psychosocial and Community Health, University of Washington, Seattle, WA 98195
| | - Michael T. Smith
- Johns Hopkins University, School of Medicine, Behavioral Medicine Research Laboratory and Clinic, Joseph Brady, Behavioral Biology Building, STE 100, 5510 Nathan Shock Drive, Baltimore, MD 21224
| | - Michael V. Vitiello
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195
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Tu TTH, Takenoshita M, Matsuoka H, Watanabe T, Suga T, Aota Y, Abiko Y, Toyofuku A. Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review. Biopsychosoc Med 2019; 13:1. [PMID: 30733824 PMCID: PMC6357406 DOI: 10.1186/s13030-019-0142-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Burning Mouth Syndrome (BMS), a chronic intraoral burning sensation or dysesthesia without clinically evident causes, is one of the most common medically unexplained oral symptoms/syndromes. Even though the clinical features of BMS have been astonishingly common and consistent throughout the world for hundreds of years, BMS remains an enigma and has evolved to more intractable condition. In fact, there is a large and growing number of elderly BMS patients for whom the disease is accompanied by systemic diseases, in addition to aging physical change, which makes the diagnosis and treatment of BMS more difficult. Because the biggest barrier preventing us from finding the core pathophysiology and best therapy for BMS seems to be its heterogeneity, this syndrome remains challenging for clinicians. In this review, we discuss currently hopeful management strategies, including central neuromodulators (Tricyclic Antidepressants - TCAs, Serotonin, and Norepinephrine Reuptake Inhibitors - SNRIs, Selective Serotonin Reuptake Inhibitors - SSRIs, Clonazepam) and solutions for applying non-pharmacology approaches. Moreover, we also emphasize the important role of patient education and anxiety management to improve the patients’ quality of life. A combination of optimized medication with a short-term supportive psychotherapeutic approach might be a useful solution.
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Affiliation(s)
- Trang T H Tu
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Miho Takenoshita
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Hirofumi Matsuoka
- 2Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Takeshi Watanabe
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Takayuki Suga
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Yuma Aota
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Yoshihiro Abiko
- 3Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Akira Toyofuku
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
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