Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 31, 2021
Date Accepted: Feb 9, 2022
Internet-delivered cognitive behavioural therapy for insomnia comorbid with chronic pain:A randomised controlled trial
ABSTRACT
Background:
Chronic pain patients often suffer from insomnia symptoms. Pain initiates, maintains, and exacerbates insomnia symptoms and vice-versa, indicating a complex situation with an additional burden for those patients. Hence, the evaluation of insomnia-related interventions for patients with chronic pain is important.
Objective:
In this randomised controlled trial (RCT), we examined the effectiveness of internet-based cognitive behavioural therapy for insomnia (ICBT-i ) for reducing insomnia severity and other sleep- and pain-related parameters in patients with chronic pain. Participants were recruited from the Swedish Quality Registry for Pain Rehabilitation (SQRP).
Methods:
We included 54 patients (mean age=49.3; SD=12.3) who were randomly assigned to ICBT-i condition and 24 to an active control condition (Applied Relaxation). Both treatment conditions were delivered via the internet. The Insomnia Severity Index (ISI), a sleep diary, and a battery of anxiety, depression, and pain-related parameter measurements were assessed at baseline, after treatment, and at a six-month follow-up (only ISI, anxiety, depression, and pain-related parameters). For the ISI and sleep diary, we also recorded weekly measurements during the five-week treatment. Negative effects were also monitored and reported.
Results:
Results showed a significant immediate interaction effect (time by treatment) on the ISI and other sleep parameters, namely sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. Participants in the Applied Relaxation group reported no significant immediate improvements, but both groups exhibited a time effect for anxiety and depression at the six-month follow-up. No significant improvements on pain-related parameters were found. At the six-month follow-up, both the ICBT-i and Applied Relaxation groups had similar sleep parameters. For both treatment arms, increased stress was the most frequently reported negative effect.
Conclusions:
In patients with chronic pain, brief ICBT-i leads to a more rapid decline in insomnia symptoms than Applied Relaxation. As these results are unique, further research is needed to investigate the effect of ICBT-i on a larger sample size of people with chronic pain. Using both treatments might lead to an even better outcome in those suffering from comorbid insomnia and chronic pain. Clinical Trial: ClinicalTrials.gov NCT03425942 https://clinicaltrials.gov/ct2/show/NCT03425942
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