1
|
Salazar-Méndez J, Viscay-Sanhueza N, Pinto-Vera C, Oyarce-Contreras F, Parra-Vera MF, Suso-Martí L, Guzmán-Muñoz E, López-Bueno R, Núñez-Cortés R, Calatayud J. Cognitive behavioral therapy for insomnia in people with chronic musculoskeletal pain. A systematic review and dose-response meta-analysis. Sleep Med 2024; 122:20-26. [PMID: 39111059 DOI: 10.1016/j.sleep.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 09/12/2024]
Abstract
The aims were (i) to determine the effects of Cognitive behavioral therapy for insomnia (CBT-I) on sleep disturbances, pain intensity and disability in patients with chronic musculoskeletal pain (CMP), and (ii) to determine the dose-response association between CBT-I dose (total minutes) and improvements in sleep disorders, pain intensity and disability in patients with CMP. A comprehensive search was conducted in PubMed/MEDLINE, Web of Science, CINAHL, and SCOPUS until December 17, 2023. Randomized clinical trials (RCTs) using CBT-I without co-interventions in people with CMP and sleep disorders were eligible. Two reviewers independently extracted data and assessed risk of bias and certainty of the evidence. A random effects meta-analysis was applied to determine the effects on the variables of interest. The dose-response association was assessed using a restricted cubic spline model. Eleven RCTs (n = 1801 participants) were included. We found a significant effect in favor of CBT-I for insomnia (SMD: -1.34; 95%CI: -2.12 to -0.56), with a peak effect size at 450 min of CBT-I (-1.65, 95%CI: -1.89 to -1.40). A non-significant effect was found for pain intensity. A meta-analysis of disability was not possible due to the lack of data. This review found benefits of CBT-I for insomnia compared to control interventions, with a large effect size. In addition, it was estimated that a 250-min dose of CBT-I had a large effect on reducing insomnia and that the peak effect was reached at 450 min. These novel findings may guide clinicians in optimizing the use of CBT-I in people with CMP and insomnia.
Collapse
Affiliation(s)
- Joaquín Salazar-Méndez
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile; Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Nelson Viscay-Sanhueza
- Unidad de Medicina Física y Rehabilitación, Hospital Dr. Gustavo Fricke, Viña del Mar, Chile
| | - Catalina Pinto-Vera
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | | | | | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Eduardo Guzmán-Muñoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark
| |
Collapse
|
2
|
Katmeh T, Gardner DM, Kiepek N, Macdonald M, Murphy AL. Sleep should not be this difficult: An interpretive descriptive study of older adults' perspectives on behaviour change elements in Sleepwell and experiences with benzodiazepine discontinuation. J Sleep Res 2024:e14282. [PMID: 38945830 DOI: 10.1111/jsr.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/07/2024] [Accepted: 06/18/2024] [Indexed: 07/02/2024]
Abstract
Benzodiazepine receptor agonists are often used for insomnia in older adults contrary to current evidence. The harms outweigh the benefits, which are limited. Cognitive behavioural therapy for insomnia is the first-line recommended treatment. Sleepwell was created as a repository of evidence-based resources to promote cognitive behavioural therapy for insomnia and limit benzodiazepine receptor agonist use. This qualitative study uses an interpretive description design and reflexive thematic analysis to explore older adults' perspectives on behavioural change techniques used in Sleepwell resources. It also explores challenges and opportunities towards benzodiazepine receptor agonist discontinuation and cognitive behavioural therapy for insomnia use. Participants were recruited from the Sleepwell arm of a randomized controlled trial. Data were collected from 15 older adults using semi-structured interviews. Two main themes were developed: (1) sleep should not be this difficult; and (2) whether you know it, or learn it, drugs are bad. Two sub-themes were created within the first theme: (1) justification of benzodiazepine receptor agonist use to achieve sleep goals; (2) efforts of committing to cognitive behavioural therapy for insomnia. Several behavioural change techniques (e.g. information about consequences, anticipated regret, salience of consequences) were enablers of benzodiazepine receptor agonist-related behaviour change. For committing to cognitive behavioural therapy for insomnia, several behavioural change techniques (e.g. self-monitoring of behaviour, distraction, stimulus substitution) were beneficial, but social support, which was perceived as useful, was absent. Older adults experienced tension with benzodiazepine receptor agonist use and deprescribing, despite knowing or learning the potential consequences of benzodiazepine receptor agonists. Cognitive behavioural therapy for insomnia implementation was challenging. Embedded behavioural change techniques in the Sleepwell booklets were identified as helpful, but more (e.g. social support) are needed to optimize cognitive behavioural therapy for insomnia use.
Collapse
Affiliation(s)
- Tulayla Katmeh
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David M Gardner
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Niki Kiepek
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea L Murphy
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
3
|
Allen N, Crock L, Chun T, Reinhard MJ. Investigating a clinically informed sleep disturbance threshold for physical and mental health among Gulf War Illness veterans. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae018. [PMID: 38616799 PMCID: PMC11015895 DOI: 10.1093/sleepadvances/zpae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/14/2024] [Indexed: 04/16/2024]
Abstract
Study Objectives This study (1) assessed sleep quality and health in Gulf War veterans (GWV) meeting the Gulf War Illness (GWI) criteria and (2) compared health associations for both those meeting a "clinically disturbed sleep" threshold, and those below, as determined by the Pittsburgh Sleep Quality Index (PSQI) cutoff for military populations (≥10) on measures of physical, mental, and cognitive health. Methods Participant data consisted of questionnaires and assessments completed prior to group assignment in a clinical trial. The sample consisted of 147 GWV, where 81.0% were males, and the median age was 53.4 years. Results The mean (SD) PSQI global score was 12.34 (4.00) with 61% of the sample qualifying as clinically disturbed sleepers according to the cutoff (global PSQI ≥ 10). GWI veterans with PSQI scores ≥10 did not differ from others in age (p = 0.20), sex (p = 0.19), or years of education (p = 0.87), but showed worse GW-related symptomology on the Gulf War Kansas questionnaire (p < 0.01), and poorer mental health on the Veterans Rand-36 (p < 0.01). Conclusions Disturbed sleep was associated with measures of pain, fatigue, and cognitive health. Our results suggest that a previously determined clinical threshold for clinically disturbed sleep is useful when examining the health status of the study population. Given that GWI is associated with elevated PSQI scores and a high frequency of disturbed sleep, cutoffs determining sleep health should be sensitive to population exposures and health history to improve interpretability.
Collapse
Affiliation(s)
- Nathaniel Allen
- Department of Veterans Affairs,War Related Illness and Injury Study Center (WRIISC), Washington, DC, USA
| | - Lucas Crock
- Department of Veterans Affairs,War Related Illness and Injury Study Center (WRIISC), Washington, DC, USA
| | - Timothy Chun
- Department of Veterans Affairs,War Related Illness and Injury Study Center (WRIISC), Washington, DC, USA
| | - Matthew J Reinhard
- Department of Veterans Affairs,War Related Illness and Injury Study Center (WRIISC), Washington, DC, USA
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
| |
Collapse
|
4
|
Erickson AJ, Ravyts SG, Dzierzewski JM, Carlson GC, Kelly MR, Song Y, McGowan SK, Mitchell MN, Washington DL, Yano EM, Alessi CA, Martin JL. Pain in your day? Get sleep treatment anyway! The role of pain in insomnia treatment efficacy in women veterans. J Sleep Res 2024:e14147. [PMID: 38246598 PMCID: PMC11260272 DOI: 10.1111/jsr.14147] [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: 08/10/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024]
Abstract
Insomnia and pain disorders are among the most common conditions affecting United States adults and veterans, and their comorbidity can cause detrimental effects to quality of life among other factors. Cognitive behavioural therapy for insomnia and related behavioural therapies are recommended treatments for insomnia, but chronic pain may hinder treatment benefit. Prior research has not addressed how pain impacts the effects of behavioural insomnia treatment in United States women veterans. Using data from a comparative effectiveness clinical trial of two insomnia behavioural treatments (both including sleep restriction, stimulus control, and sleep hygiene education), we examined the impact of pain severity and pain interference on sleep improvements from baseline to post-treatment and 3-month follow-up. We found no significant moderation effects of pain severity or interference in the relationship between treatment phase and sleep outcomes. Findings highlight opportunities for using behavioural sleep interventions in patients, particularly women veterans, with comorbid pain and insomnia, and highlight areas for future research.
Collapse
Affiliation(s)
- Alexander J. Erickson
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Scott G. Ravyts
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Gwendolyn C. Carlson
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, California, USA
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Monica R. Kelly
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Yeonsu Song
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
- School of Nursing, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Sarah Kate McGowan
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, California, USA
| | - Michael N. Mitchell
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Donna L. Washington
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Elizabeth M. Yano
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Cathy A. Alessi
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Jennifer L. Martin
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| |
Collapse
|
5
|
Dos Santos Bento AP, Filho NM, Ferreira ADS, Cassetta AP, de Almeida RS. Sleep quality and polysomnographic changes in patients with chronic pain with and without central sensitization signs. Braz J Phys Ther 2023; 27:100504. [PMID: 37146510 DOI: 10.1016/j.bjpt.2023.100504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/15/2023] [Accepted: 04/03/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Insufficient sleep is common nowadays and it can be associated with chronic pain. OBJECTIVE To describe the main polysomnographic findings in patients with chronic musculoskeletal pain and to estimate the association between sleep quality, polysomnography variables and chronic musculoskeletal pain. METHODS This cross-sectional research analyzed a database from polysomnography type 1 exams results and then collected data via an electronic form from these patients. The form collected sociodemographic data and presented clinical questionnaires for measuring sleep quality, sleepiness, pain intensity and central sensitization signs. Pearson's correlation coefficient and odds ratio were used to estimate the associations. RESULTS The mean age of the respondents was 55.1 (SD 13.4) years. The mean score of the Central Sensitization Inventory showed signs of central sensitization (50.1; SD 13.4) in the participants. Most patients (86%) had 1 or more nocturnal awakenings, 90% had one or more episodes of sleep apnea, 47% had Rapid Eye Movement sleep phase latency greater than 70-120 min and the mean sleep efficiency among all participants was 81.6%. The Pittsburgh Sleep Quality Index score was correlated with the CSI score (r = 0.55; 95% CI: 0.45, 0.61). People with central sensitization signs have 2.6 times more chance to present sleep episodes of blood oxygen saturation below 90% (OR = 2.62; 95% CI:1.23, 6.47). CONCLUSION Most people with central sensitization signs had poor sleep quality, night waking episodes and specific disturbances in sleep phases. The findings showed association between central sensitization, sleep quality, nocturnal awakening, and changes in blood oxygen saturation during sleep.
Collapse
Affiliation(s)
- Ana Paula Dos Santos Bento
- Master Student in Post Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Ney Meziat Filho
- Post Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Arthur de Sá Ferreira
- Post Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Ana Paula Cassetta
- Sleep Medicine Laboratory, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ, Brazil
| | - Renato Santos de Almeida
- Post Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil; Physical Therapy Department. Centro Universitário Serra dos Órgãos (UNIFESO), Teresópolis, Brazil.
| |
Collapse
|
6
|
Gupta CC, Sprajcer M, Johnston-Devin C, Ferguson SA. Sleep hygiene strategies for individuals with chronic pain: a scoping review. BMJ Open 2023; 13:e060401. [PMID: 36731933 PMCID: PMC9896248 DOI: 10.1136/bmjopen-2021-060401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Up to a quarter of the world's population experience chronic pain, which, in addition to interfering with daily activities and waking function, is often associated with poor sleep. Individuals experiencing poor sleep are often encouraged to implement sleep hygiene strategies. However, current sleep hygiene strategies have not been developed considering the unique challenges faced by individuals with chronic pain and therefore they might not be as effective in this population. The aim of this scoping review is to map the state of the existing literature examining sleep hygiene strategies in individuals with chronic pain. DESIGN This scoping review included a search of four online databases (Medline, Embase, PsycINFO and CINAHL) to identify articles examining the use of sleep hygiene strategies in populations with chronic pain. RESULTS Thirty articles investigated at least one sleep hygiene strategy in individuals with chronic pain, with improvements to sleep reported for six sleep hygiene strategies (education, exercise, limiting alcohol use, limiting tobacco use, prebed state and sleep environment). However, the timing of these strategies was often not reported which limits the degree to which these strategies can be generalised for use as a presleep strategy. CONCLUSION This scoping review examined the existing literature focusing on sleep hygiene strategies for people with chronic pain. There are limitations to the methodology of the existing literature and gaps in our understanding of sleep hygiene strategies in some chronic pain conditions that must be addressed in future research before the effectiveness of these strategies can be understood.
Collapse
Affiliation(s)
- Charlotte C Gupta
- Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
| | - Madeline Sprajcer
- Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
| | - Colleen Johnston-Devin
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
|
9
|
Ravyts SG, Perez E, Dzierzewski JM. Pain-related beliefs about sleep as a predictor of insomnia symptoms and treatment acceptability. Sleep Med 2022; 96:122-127. [PMID: 35640499 PMCID: PMC9205612 DOI: 10.1016/j.sleep.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Dysfunctional beliefs about sleep and pain are common among individuals experiencing recurrent pain and may inadvertently maintain insomnia symptoms. Thus, the present study sought to determine the level at which pain-related beliefs about sleep may predict insomnia and assess whether pain-related beliefs about sleep predict attitudes towards insomnia treatment above other known factors. PATIENTS/METHODS Data consisted of 999 individuals (M age = 44.18, 45.75% male) who participated in an online study about sleep and health across the lifespan. Beliefs about sleep and pain were measured via the pain-related beliefs and attitudes scale (PBAS) while insomnia and pain were assessed using the insomnia severity index (ISI) and a visual analogy scale, respectively. Attitudes towards insomnia treatment was measured using the insomnia treatment acceptability scale (ITAS). RESULTS AND CONCLUSION A score of 6.10 out of 10 on PBAS optimized sensitivity (66.40%) and specificity (66.90%) for insomnia classification. Pain-related beliefs about sleep predicted treatment acceptability of both behavioral (β = .46, p <. 001) and pharmacological treatments (β = 0.50, p < .001) over and above insomnia symptoms, pain severity, or sleep-self efficacy. Results underscore the importance of cognitive-behavioral factors as it relates to insomnia among individuals with comorbid pain and are relevant to the developments of models which seek to understand attitudes towards insomnia treatment.
Collapse
|
10
|
Tkachenko V, Korabelnikova E. Comorbidity of tension headache and insomnia. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:46-52. [DOI: 10.17116/jnevro202212203146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Tscharaktschiew N, Ende L, Onderka C. [Better Sleep and Less Pain? Sleep Training in Orthopedic Rehabilitation]. REHABILITATION 2021; 61:35-42. [PMID: 34425599 DOI: 10.1055/a-1509-9247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE There is high comorbidity between chronic pain and insomnia. Not only does chronic pain impair sleep, poor sleep quality can also exacerbate the sensation of pain. However, usually, the respective symptoms are treated separately. We evaluate a new cognitive behavioral sleep-pain-training aiming at improving symptoms of both insomnia and chronic pain in the setting of ambulant orthopedic rehabilitation. METHODS N=41 patients participated in the study (with 15 participants being enrolled in the control group). The training consists of 4 modules á 90min and was explicitly developed for patients suffering from chronic pain and comorbid insomnia. It includes several methods of cognitive behavioral therapy for the treatment of insomnia and pain (e. g., sleep hygiene, sleep restriction, sleep-pain-protocol, cognitive restructuring) and specifically addresses the relationship between the two. Sleep quality, sleep related thoughts (focusing, rumination), internal health locus of control, pain intensity (day and night) as well as pain related thoughts (pain related anxiety, pain related depression/helplessness) were assessed pre and post training by means of a questionnaire. RESULTS Mixed ANOVAS revealed small (η²=: 0,010) to medium (η²=: 0,068) interaction effects for most dependent variables (sleep quality, sleep efficiency, focusing, rumination, internal health locus of control, average day and night pain, maximum night pain, pain related anxiety and pain related depression/helplessness) for the interaction of time and group. However, effects for rumination and average day pain were not significant. There was no interaction effect for maximum day pain. Effect sizes for single group analyses revealed medium (internal sleep locus of control: d=0,52) to large (sleep quality: d=1,73) significant effects for the training group and no (focusing: d=0,00) to small (maximum day pain: d=-0,43) and non-significant effects for the control group. CONCLUSION The training analyzed in this study may constitute a complement to existing treatment possibilities for patients suffering from chronic pain and should be further evaluated in larger samples.
Collapse
Affiliation(s)
| | - Luisa Ende
- Institut für Psychologie, Technische Universität Chemnitz
| | | |
Collapse
|
13
|
Sharma S, Ferreira-Valente A, de C Williams AC, Abbott JH, Pais-Ribeiro J, Jensen MP. Group Differences Between Countries and Between Languages in Pain-Related Beliefs, Coping, and Catastrophizing in Chronic Pain: A Systematic Review. PAIN MEDICINE 2021; 21:1847-1862. [PMID: 32044980 PMCID: PMC7553014 DOI: 10.1093/pm/pnz373] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective To evaluate the extent to which pain-related beliefs, appraisals, coping, and catastrophizing differ between countries, language groups, and country economy. Design Systematic review. Methods Two independent reviewers searched 15 databases without restriction for date or language of publication. Studies comparing pain beliefs/appraisals, coping, or catastrophizing across two or more countries or language groups in adults with chronic pain (pain for longer than three months) were included. Two independent reviewers extracted data and performed the quality appraisal. Study quality was rated as low, moderate, or high using a 10-item modified STROBE checklist. Effect sizes were reported as small (0.20–0.49), medium (0.50–0.79), or large (≥0.80). Results We retrieved 1,365 articles, read 42 potential full texts, and included 10 (four moderate-quality, six low-quality) studies. A total of 6,797 adults with chronic pain (33% with chronic low back pain) were included from 16 countries. Meta-analysis was not performed because of heterogeneity in the studies. A total of 103 effect sizes were computed for individual studies, some of which indicated between-country differences in pain beliefs, coping, and catastrophizing. Of these, the majority of effect sizes for pain beliefs/appraisal (60%; eight large, eight medium, and eight small), for coping (60%; seven large, 11 medium, and 16 small), and for catastrophizing (50%; two medium, one small) evidenced statistically significant between-country differences, although study quality was low to moderate. Conclusions In 50% or more of the studies, mean scores in the measures of pain beliefs and appraisals, coping responses, and catastrophizing were significantly different between people from different countries.
Collapse
Affiliation(s)
- Saurab Sharma
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | | | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - José Pais-Ribeiro
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
14
|
Saconi B, Polomano RC, Compton PC, McPhillips MV, Kuna ST, Sawyer AM. The influence of sleep disturbances and sleep disorders on pain outcomes among veterans: A systematic scoping review. Sleep Med Rev 2020; 56:101411. [PMID: 33348172 DOI: 10.1016/j.smrv.2020.101411] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/21/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
Chronic nonmalignant pain, sleep disturbances and sleep disorders are highly prevalent conditions among U.S. military veterans. Evidence summaries highlight the influence of sleep on pain outcomes in the general adult population but not for the military veteran population. This is a significant gap as U.S. military veterans are an exceedingly high-risk population for both chronic pain and sleep disturbances and/or disorders. We aimed to review the influence of sleep disturbances and sleep disorders on pain outcomes among veterans with chronic nonmalignant pain. A systematic scoping review was conducted using PubMed/Medline, EMBASE, Scopus, CINAHL, and PsycINFO. Twenty-six out of 1450 studies from initial search were included in this review resulting in a combined sample size of N = 923,434 participants. Sleep disturbances and sleep disorders were associated with worse pain outcomes among veterans with chronic pain. Treatment-induced sleep improvements ameliorated pain outcomes in veterans with sleep disorders and sleep disturbances. Research is indicated to address an overlooked pain treatment opportunity - that of sleep disturbance and sleep disorder management.
Collapse
Affiliation(s)
- Bruno Saconi
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - Rosemary C Polomano
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care, USA.
| | - Peggy C Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Miranda V McPhillips
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA.
| | - Samuel T Kuna
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA.
| | - Amy M Sawyer
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA.
| |
Collapse
|