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Cramer L, Vogt F, McKenna L, Marks E. How people with tinnitus-related insomnia experience group CBT-for-insomnia (CBTi): a thematic analysis. Int J Audiol 2024; 63:190-198. [PMID: 36645178 DOI: 10.1080/14992027.2022.2161016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 01/17/2023]
Abstract
Objective: Although insomnia often compounds tinnitus, sleeping problems in people experiencing tinnitus are rarely treated. This study investigates the experiences of participants receiving Cognitive Behavioural Therapy for insomnia (CBTi) as part of a randomised controlled trial for managing tinnitus-related insomnia. The aim of this study is to gain detailed insight into participants' perceptions and experiences of this treatment.Design: Semi-structured interviews were conducted via phone or in-person by one of the two clinical psychologists who facilitated the CBTi sessions. Reflexive thematic analysis with semantic inductive approach was used for analysis to keep the research question theoretically flexible.Study samples: Eight participants (three females, age range 32-69 years) were interviewed six months after CBTi completion.Results: Three superordinate themes were identified: "Common humanity and transcending individual distress," "Changing the things I can" and "Accepting the things I cannot change." The group environment helped participants to normalise their experiences. Reliable tinnitus/sleep information and robust behavioural change techniques helped participants to respond and relate to their condition differently.Conclusion: Generally, participants reported long-term benefits from CBTi to treat tinnitus-related insomnia, particularly increased confidence, and getting on with life. CBTi is multi-component, so clinicians need to respond to individual preferences and lifestyles.
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Affiliation(s)
| | - Florian Vogt
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | - Laurence McKenna
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, London, UK
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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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Themelis K, Tang NKY. The Management of Chronic Pain: Re-Centring Person-Centred Care. J Clin Med 2023; 12:6957. [PMID: 38002572 PMCID: PMC10672376 DOI: 10.3390/jcm12226957] [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: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The drive for a more person-centred approach in the broader field of clinical medicine is also gaining traction in chronic pain treatment. Despite current advances, a further departure from 'business as usual' is required to ensure that the care offered or received is not only effective but also considers personal values, goals, abilities, and day-to-day realities. Existing work typically focuses on explaining pain symptoms and the development of standardised interventions, at the risk of overlooking the broader consequences of pain in individuals' lives and individual differences in pain responses. This review underscores the importance of considering additional factors, such as the influence of chronic pain on an individual's sense of self. It explores innovative approaches to chronic pain management that have the potential to optimise effectiveness and offer person-centred care. Furthermore, it delves into research applying hybrid and individual formulations, along with self-monitoring technologies, to enhance pain assessment and the tailoring of management strategies. In conclusion, this review advocates for chronic pain management approaches that align with an individual's priorities and realities while fostering their active involvement in self-monitoring and self-management.
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Affiliation(s)
- Kristy Themelis
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
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Deo P, Leupold O, Rau O, Cheng J, Prather H. Evaluation of sleep health documentation and sleep-related intervention by physiatrists treating musculoskeletal disorders: A retrospective investigation. PM R 2023. [PMID: 37916613 DOI: 10.1002/pmrj.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Sleep health is linked to pain, function, and global health. Unfortunately, sleep health may not be consistently addressed as a part of musculoskeletal care. OBJECTIVE To describe the frequency of sleep health documentation and intervention by musculoskeletal physiatrists. Additionally, patient-reported outcome measures were compared between patients with and without sleep impairment. We hypothesized that sleep health is documented and addressed in less than half of initial patient encounters and that patients with a sleep impairment have worse patient-reported outcomes scores compared to those without sleep impairment. DESIGN Retrospective study. SETTING Tertiary orthopedic hospital. INTERVENTIONS None. MAIN OUTCOME MEASURES Frequency of provider documentation of sleep health, frequency and characteristics of sleep health intervention provided, and Patient-Reported Outcome Measurement Information System (PROMIS)-10 mental health and physical health scores. RESULTS Initial visits for a musculoskeletal condition of 39,452 patients from January 1, 2020 to October 1, 2022 were included. Documentation of sleep health was found in 33.0% (13,002/39,452) of patients. Of those with sleep health documentation, 59.2% (7697/13,002) were classified as having a sleep impairment. Only 19.0% of patients were provided with sleep-related education or other intervention. Patients with a sleep impairment had worse PROMIS-10 mental health and physical health scores (p < .001), as compared to those without a sleep impairment. CONCLUSIONS Patients with sleep impairment had worse mental and physical health scores than those without sleep impairment, and only 19.0% received sleep health intervention. These data suggest that sleep impairment is common in patients presenting for evaluation of a musculoskeletal condition, and advanced provider education and tools to help patients improve their sleep health are needed.
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Affiliation(s)
- Prabhav Deo
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Olivia Leupold
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Olivia Rau
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Heidi Prather
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
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Mun CJ, Winsick N, Wegener ST, Youngstedt SD, Campbell CM, Aaron RV. Medium- and Long-Term Effects of Insomnia Severity and Circadian Preference on Pain and Emotional Distress Among Individuals With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:1946-1956. [PMID: 37286095 PMCID: PMC10615674 DOI: 10.1016/j.jpain.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
Studies have identified insomnia as having significant influence on chronic pain. A rising body of research has also underscored the association between eveningness and chronic pain. However, co-assessment of insomnia and eveningness in the context of chronic pain adjustment has been limited. The present study sought to investigate the effects of insomnia and eveningness on pain severity, pain interference, and emotional distress (ie, depressive and anxiety symptoms) over nearly 2 years among adults with chronic pain in the U.S. Adults with chronic pain (N = 884) were surveyed 3 times via Amazon's MTurk online crowdsourcing platform: baseline, 9-month follow-up, and 21-month follow-up. Path analysis was conducted to examine the effects of baseline insomnia severity (Insomnia Severity Index) and eveningness (Morningness and Eveningness Questionnaire), as well as their moderating effects on outcomes. Controlling for select sociodemographic variables and baseline outcome levels, greater insomnia severity at baseline was associated with worsening of all of the pain-related outcomes at 9-month follow-up, and pain interreference and emotional distress at 21-month follow-up. We did not find evidence that evening types are at a higher risk of experiencing worsening pain-related outcomes over time compared to morning and intermediate types. There were also no significant insomnia severity and eveningness moderation effects on any outcome. Our findings suggest that insomnia is a more robust predictor of changes in pain-related outcomes as compared to eveningness. Treatment of insomnia can be important in chronic pain management. Future studies should evaluate the role of circadian misalignment on pain using more accurate biobehavioral makers. PERSPECTIVE: This study examined the effects of insomnia and eveningness on pain and emotional distress in a large sample of individuals with chronic pain. Insomnia severity is a stronger predictor of changes in pain and emotional distress than eveningness, highlighting insomnia as an important clinical target for chronic pain management.
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Affiliation(s)
- Chung Jung Mun
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Nina Winsick
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Shawn D Youngstedt
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
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Hu L, Wang EJH. Sleep as a Therapeutic Target for Pain Management. Curr Pain Headache Rep 2023; 27:131-141. [PMID: 37162641 DOI: 10.1007/s11916-023-01115-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a summary of the utilization of sleep as a therapeutic target for chronic pain and to evaluate the recent literature on current and proposed pharmacologic and non-pharmacologic sleep interventions used in the management of pain disorders. RECENT FINDINGS Sleep is a promising therapeutic target in the treatment of pain disorders with both non-pharmacologic and pharmacologic therapies. Non-pharmacologic therapies include cognitive behavioral therapy and sensory-based therapies such as pink noise, audio-visual stimulation, and morning bright light therapy. Pharmacologic therapies include melatonin, z-drugs, gabapentinoids, and the novel orexin antagonists. However, more research is needed to clarify if these therapies can improve pain specifically by improving sleep. There is a vast array of investigational opportunities in sleep-targeted therapies for pathologic pain, and larger controlled, prospective trials are needed to fully elucidate their efficacy.
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Affiliation(s)
- Lizbeth Hu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Eric Jyun-Han Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Blaustein Pain Treatment Center, 601 North Caroline Street, Suite 3062, Baltimore, MD, 21287, USA.
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Barry G, Marks E. Cognitive–behavioral factors in tinnitus-related insomnia. Front Psychol 2023; 14:983130. [PMID: 37008859 PMCID: PMC10064054 DOI: 10.3389/fpsyg.2023.983130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/14/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundA significant proportion of individuals with distressing tinnitus also report insomnia. Limited, but emerging, evidence suggests that tinnitus-related insomnia cannot be explained only by the presence of tinnitus and that sleep-related cognitive–behavioral processes may play a key role in exacerbating tinnitus-related insomnia.ObjectivesThis study aimed to assess whether sleep-related cognitions and behaviors believed to maintain insomnia disorder are present in individuals with tinnitus-related insomnia.MethodsThis between-groups study recruited 180 participants online for four groups: tinnitus-related insomnia (N = 49), insomnia disorder without tinnitus (N = 34), tinnitus sufferers who are good sleepers (N = 38), and controls (N = 59). They completed questionnaires assessing insomnia severity, sleep-related cognitions and behaviors, sleep quality, anxiety, and depression. People with tinnitus completed a measure of tinnitus severity and rated the loudness of their tinnitus on a subjective measure.ResultsLinear regression demonstrated that group significantly predicted sleep related thoughts and behaviors, and sleep quality. Pairwise comparisons showed that the tinnitus-related insomnia group had significantly greater insomnia-related thoughts and behaviors and significantly worse sleep quality than tinnitus-good sleepers. No differences were seen between the tinnitus-related insomnia and the insomnia groups. The tinnitus-related insomnia group had significantly higher depression, anxiety, and tinnitus distress than tinnitus-good sleepers.ConclusionFindings suggest that tinnitus-related insomnia may be maintained by cognitive–behavioral processes similar to those found in insomnia disorder. Such processes are more important than tinnitus severity when understanding sleep disturbance. People with tinnitus-related insomnia may benefit from treatments such as cognitive–behavioral therapy for insomnia.
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The Effect of Shiatsu Therapy on Sleep Quality in Patients With Low Back Pain: A Secondary Analysis. Holist Nurs Pract 2023; 37:71-77. [PMID: 36790421 DOI: 10.1097/hnp.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of this study is to investigate the efficacy of shiatsu therapy for chronic low back pain and sleep disturbance. We conducted a secondary analysis of the randomized trial at a large academic hospital in Tokyo. Patients with chronic low back pain were included. Patients were randomly assigned to either shiatsu therapy in addition to standard care or standard care only by computer randomization. Our primary outcome was improvement of the global Pittsburgh Sleep Quality Index (PSQI) score, and the secondary outcomes were improvement in each component of the PSQI at weeks 4 and 8. We included a total of 59 patients. The mean age was 67.8 (SD: 13.5) years, and 21 patients (35.6%) were male. The global PSQI scores improved in the intervention group at week 4 (adjusted β coefficient: 1.16, 95% confidence interval: 0.10-2.21) and week 8 (adjusted β coefficient: 1.82, 95% confidence interval: 0.74-2.90). In terms of each component of the PSQI, sleep efficiency (component 4) and sleep disturbance (component 5) were improved, but use of sleep medication (component 5) worsened in the intervention group compared with the control group in several models. Shiatsu therapy in addition to standard therapy for chronic low back pain may improve sleep quality after intervention.
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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: 6] [Impact Index Per Article: 3.0] [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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Yang YY, Jun S. The Effects of Cognitive Behavioral Therapy for Insomnia among College Students with Irritable Bowel Syndrome: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14174. [PMID: 36361052 PMCID: PMC9658882 DOI: 10.3390/ijerph192114174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The aim of the study was to develop and evaluate cognitive behavioral therapy for insomnia (CBT-I) among college students with irritable bowel syndrome (IBS). We randomly assigned 60 college students with IBS comorbid insomnia to the experimental group who received CBT-I for 90 min once a week for 4 weeks and the control (non-CBT-I) group. Participants completed self-report measures of insomnia severity, pre-sleep arousal, sleep-related dysfunctional cognitions, maladaptive sleep habits, IBS symptom severity and IBS quality of life (QOL) at baseline, after intervention, and at 3-month follow-up. Sleep pattern, GI symptoms during sleep and Interleukin-6 (IL-6) and C-Reaction Protein (CRP) were measured at baseline and after intervention. The experimental group showed significant decreases in insomnia severity, sleep onset latency, total time in bed, pre-sleep arousal, GI symptoms during sleep, sleep-related dysfunctional cognitions, maladaptive sleep habits, and IBS symptom severity, compared with the control group. This group also showed significant increases in sleep efficiency and IBS QOL compared with the control group. No significant differences were observed between the levels of IL-6 and CRP of both groups. CBT-I for college students with comorbid IBS and insomnia was effective in reducing insomnia, IBS symptom severity, and IBS QOL.
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Affiliation(s)
- Yun-Yi Yang
- Department of Nursing, Healthcare Science & Human Ecology, Dong-Eui University, Busan 47340, Korea
| | - Sangeun Jun
- College of Nursing, Keimyung University, Daegu 42601, Korea
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Iwashita M, Yamadera W, Hotchi A, Utsumi T, Amagai M, Ishii J, Suzuki T, Itoh H, Shigeta M. Comparison of the effects of cognitive-behavioral therapy for insomnia between patients with primary insomnia and comorbid insomnia. Sleep Biol Rhythms 2022; 20:489-497. [PMID: 38468614 PMCID: PMC10900042 DOI: 10.1007/s41105-022-00395-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/13/2022] [Indexed: 12/19/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is effective for not only primary insomnia (PI) but also comorbid insomnia (CI; insomnia associated with psychiatric/physical diseases or other types of sleep disorders). This study aimed to compare the outcomes of CBT-I implemented in the same manner between patients with PI and CI. In total, 41 adult patients who had completed CBT-I were enrolled in this retrospective analysis and divided into a PI group and a CI group. The authors then examined and compared the significance of changes after therapy between the two groups. The magnitude of improvement on the Japanese version of the Insomnia Severity Index (ISI-J) was analyzed as the primary endpoint. In the PI group (n = 24), both the ISI-J score and the dose of hypnotics decreased significantly following CBT-I. On the other hand, in the CI group (n = 17), only the dose of hypnotics decreased significantly; no statistically significant improvement was seen in the ISI-J score. Sleep onset latency and sleep quality rating in recorded sleep diaries were significantly correlated with improved ISI-J scores in the CI group only. CBT-I was shown to be effective for CI, but its efficacy for CI was inferior to that for PI in terms of impact on sleep and mental condition. These results suggest that in addition to the basic components of CBT-I, treatment for CI, especially when accompanied by severe insomnia symptoms, should include approaches targeting the comorbid disease.
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Affiliation(s)
- Masayuki Iwashita
- Department of Psychiatry, Jikei University School of Medicine, 19-18, 3-Chome, Minato-ku, Tokyo, 105-8461 Japan
- Department of Psychiatry, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Wataru Yamadera
- Department of Psychiatry, Jikei University School of Medicine, 19-18, 3-Chome, Minato-ku, Tokyo, 105-8461 Japan
- Department of Psychiatry, Jikei University Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Ayana Hotchi
- Department of Psychiatry, Jikei University School of Medicine, 19-18, 3-Chome, Minato-ku, Tokyo, 105-8461 Japan
- Department of Psychiatry, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Psychiatry, Jikei University School of Medicine, 19-18, 3-Chome, Minato-ku, Tokyo, 105-8461 Japan
- Department of Psychiatry, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Misato Amagai
- Department of Psychiatry, Jikei University School of Medicine, 19-18, 3-Chome, Minato-ku, Tokyo, 105-8461 Japan
- Department of Psychiatry, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Junpei Ishii
- Department of Psychiatry, Jikei University School of Medicine, 19-18, 3-Chome, Minato-ku, Tokyo, 105-8461 Japan
- Department of Psychiatry, Jikei University Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Takako Suzuki
- Department of Psychiatry, Jikei University School of Medicine, 19-18, 3-Chome, Minato-ku, Tokyo, 105-8461 Japan
- Department of Psychiatry, Jikei University Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Hiroshi Itoh
- Department of Psychiatry, Jikei University School of Medicine, 19-18, 3-Chome, Minato-ku, Tokyo, 105-8461 Japan
- Department of Psychiatry, Jikei University Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, Jikei University School of Medicine, 19-18, 3-Chome, Minato-ku, Tokyo, 105-8461 Japan
- Department of Psychiatry, The Jikei University Hospital, Minato-ku, Tokyo, Japan
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12
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The Association Between Sleep Disturbance and Health Outcomes in Chronic Whiplash-Associated Disorders: A Series of Mediation Analyses. Clin J Pain 2022; 38:612-619. [PMID: 36037089 DOI: 10.1097/ajp.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the association between sleep disturbance and clinical features of chronic whiplash-associated disorders. We also aimed to use a bootstrapped mediation analysis approach to systematically examine both direct and indirect pathways by which sleep disturbance may affect chronic pain and functional status. METHODS One hundred and sixty-five people (63% female) with chronic whiplash-associated disorders and not taking medications for sleep disturbance completed questionnaires evaluating sleep disturbance, pain intensity, pain interference, disability, physical and mental health quality of life, stress, anxiety, depression, pain catastrophizing, and posttraumatic stress severity. RESULTS Greater sleep disturbance was associated with increased duration of symptoms, higher levels of pain and disability, higher levels of emotional distress and pain catastrophizing, and functional impairment (reduced health-related quality of life). Mediation analyses demonstrated that sleep disturbance influenced chronic pain intensity and interference through both direct and indirect associations inclusive of stress, anxiety and pain catastrophizing. Similarly, sleep disturbance was associated with higher levels of disability and poor health-related quality of life, both directly and also through its negative association with pain intensity and interference. DISCUSSION Sleep disturbance in chronic WAD was associated with worse health outcomes and demonstrated both direct and indirect effects on both chronic pain and function.
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Van Looveren E, Meeus M, Cagnie B, Ickmans K, Bilterys T, Malfliet A, Goubert D, Nijs J, Danneels L, Moens M, Mairesse O. Combining Cognitive Behavioral Therapy for Insomnia and Chronic Spinal Pain Within Physical Therapy: A Practical Guide for the Implementation of an Integrated Approach. Phys Ther 2022; 102:6604584. [PMID: 35689809 DOI: 10.1093/ptj/pzac075] [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: 04/08/2021] [Revised: 09/13/2021] [Accepted: 12/10/2021] [Indexed: 11/14/2022]
Abstract
Most people who have nonspecific chronic spinal pain (nCSP) report comorbid insomnia. However, in current treatment strategies for nCSP, insomnia is usually not addressed. Considering the bidirectional interaction between pain and sleep and its underlying psychophysiological mechanisms, insomnia may increase the risk of developing adverse physical and psychological health outcomes and should thus no longer be left untreated. As suggested by previous pilot studies, adding cognitive behavioral therapy for insomnia to the contemporary evidence-based biopsychosocial physical therapy approach may also improve pain outcomes in nCSP. This manuscript aims to provide practical guidelines on hybrid physical therapy, including the combination of the following components: (1) pain neuroscience education (eg, to reconceptualize pain) and cognition-targeted exercise therapy (eg, graded exposure to functional daily life movements), and (2) cognitive behavioral therapy for insomnia (sleep psychoeducation, behavioral and cognitive therapy, correction of sleep hygiene, and relaxation therapy) can be deployed for the management of patients who have chronic spinal pain. Impact. Due to the major impact sleep disturbances have on pain and disability, insomnia as a comorbidity should no longer be ignored when treating patients with chronic spinal pain.
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Affiliation(s)
- Eveline Van Looveren
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kelly Ickmans
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Thomas Bilterys
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Dorien Goubert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Lieven Danneels
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maarten Moens
- Department of Neurosurgery and Radiology, University Hospital Brussels, Brussels, Belgium.,Center of Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Oliver Mairesse
- Department of Psychology - Brain, Body and Cognition (BBCO), Vrije Universiteit Brussel, Brussels, Belgium.,Brugmann University Hospital, Sleep Laboratory and Unit for Clinical Chronobiology, Brussels, Belgium
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14
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Moukhtarian TR, Patel K, Toro C, Russel S, Daly G, Walasek L, Tang NKY, Meyer C. Effects of a hybrid digital cognitive-behavioural therapy for insomnia and emotion regulation in the workplace (SLEEP): study protocol for a randomised waitlist control trial. BMJ Open 2022; 12:e058062. [PMID: 35840305 PMCID: PMC9295651 DOI: 10.1136/bmjopen-2021-058062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This trial tests the efficacy of implementing a hybrid digital cognitive-behavioural therapy for insomnia (dCBT-I) and emotion regulation (ER) in the workplace. The study protocol follows the SPIRIT (Standard Protocol Items: Recommendations for Intervention Trials) 2013 recommendations. METHODS AND ANALYSIS This is a mixed methods evaluation with a two-arm randomised waitlist control design of a 6-week dCBT-I+ER intervention through self-guided online platform and four videoconferencing therapy sessions. A process evaluation will examine the fidelity of delivery and experiences of the intervention. The primary outcomes are the Insomnia Severity Index, the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder-7. The secondary outcomes are job productivity, job satisfaction, well-being, quality of life, self-reported (sleep diary data) and objective (actigraphy) sleep parameters, and usage of online intervention platform. Assessments take place at baseline (T0), week 8 post-treatment (T1) and week 12 postrandomisation (T2). We will recruit 156 workers with sleep and ER problems ranging from subclinical to clinical levels not engaged in treatment at the time of the trial. ETHICS AND DISSEMINATION Full approval was given by the University of Warwick Biomedical and Research Ethics Committee (BSREC 45/20-21). The current protocol version is 2.9_Dec21. Publication of results will inform the scientific, clinical and business communities through peer-reviewed articles, webinars, conferences and newsletters. TRIAL REGISTRATION NUMBER ISRCTN13596153.
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Affiliation(s)
| | - Krishane Patel
- Warwick Manufacturing Group, University of Warwick, Coventry, UK
| | - Carla Toro
- Warwick Manufacturing Group, University of Warwick, Coventry, UK
| | - Sean Russel
- Health and Life Science Centre, Coventry University, Coventry, UK
| | - Guy Daly
- The British University, Cairo, Egypt
| | - Lukasz Walasek
- Department of Psychology, University of Warwick, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Caroline Meyer
- Warwick Manufacturing Group, University of Warwick, Coventry, UK
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15
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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: 5] [Impact Index Per Article: 2.5] [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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16
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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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17
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McBeth J, Dixon WG, Moore SM, Hellman B, James B, Kyle SD, Lunt M, Cordingley L, Yimer BB, Druce KL. Sleep Disturbance and Quality of Life in Rheumatoid Arthritis: Prospective mHealth Study. J Med Internet Res 2022; 24:e32825. [PMID: 35451978 PMCID: PMC9077504 DOI: 10.2196/32825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/11/2021] [Accepted: 12/27/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep disturbances and poor health-related quality of life (HRQoL) are common in people with rheumatoid arthritis (RA). Sleep disturbances, such as less total sleep time, more waking periods after sleep onset, and higher levels of nonrestorative sleep, may be a driver of HRQoL. However, understanding whether these sleep disturbances reduce HRQoL has, to date, been challenging because of the need to collect complex time-varying data at high resolution. Such data collection is now made possible by the widespread availability and use of mobile health (mHealth) technologies. OBJECTIVE This mHealth study aimed to test whether sleep disturbance (both absolute values and variability) causes poor HRQoL. METHODS The quality of life, sleep, and RA study was a prospective mHealth study of adults with RA. Participants completed a baseline questionnaire, wore a triaxial accelerometer for 30 days to objectively assess sleep, and provided daily reports via a smartphone app that assessed sleep (Consensus Sleep Diary), pain, fatigue, mood, and other symptoms. Participants completed the World Health Organization Quality of Life-Brief (WHOQoL-BREF) questionnaire every 10 days. Multilevel modeling tested the relationship between sleep variables and the WHOQoL-BREF domains (physical, psychological, environmental, and social). RESULTS Of the 268 recruited participants, 254 were included in the analysis. Across all WHOQoL-BREF domains, participants' scores were lower than the population average. Consensus Sleep Diary sleep parameters predicted the WHOQoL-BREF domain scores. For example, for each hour increase in the total time asleep physical domain scores increased by 1.11 points (β=1.11, 95% CI 0.07-2.15) and social domain scores increased by 1.65 points. These associations were not explained by sociodemographic and lifestyle factors, disease activity, medication use, anxiety levels, sleep quality, or clinical sleep disorders. However, these changes were attenuated and no longer significant when pain, fatigue, and mood were included in the model. Increased variability in total time asleep was associated with poorer physical and psychological domain scores, independent of all covariates. There was no association between actigraphy-measured sleep and WHOQoL-BREF. CONCLUSIONS Optimizing total sleep time, increasing sleep efficiency, decreasing sleep onset latency, and reducing variability in total sleep time could improve HRQoL in people with RA.
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Affiliation(s)
- John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom
| | - Susan Mary Moore
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | | | | | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, Manchester University, Manchester, United Kingdom
| | - Belay Birlie Yimer
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Katie L Druce
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
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18
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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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19
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Williams-Cooke C, LeSuer L, Drerup M, Siengsukon C. The Impact of Cognitive Behavioral Therapy for Insomnia on Sleep Log and Actigraphy Outcomes in People with Multiple Sclerosis: A Secondary Analysis. Nat Sci Sleep 2021; 13:1865-1874. [PMID: 34675730 PMCID: PMC8520446 DOI: 10.2147/nss.s324879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE While studies indicate cognitive behavioral therapy for insomnia (CBT-I) improves self-report sleep outcomes from questionnaires in people with multiple sclerosis (MS), it is unclear if CBT-I improves outcomes from a sleep log or sleep assessed objectively via actigraphy in people with MS. This study aimed to determine if CBT-I improves sleep log and actigraphy outcomes in individuals with MS. PATIENTS AND METHODS Twenty-five participants (Mage = 53.04, SD= 10.90) were included in this secondary analysis of data from a pilot randomized control study to assess the feasibility and treatment effect of CBT-I in individuals with MS. Participants were asked to maintain a sleep log and wear an actigraph for a week at baseline and post-intervention. Participants were randomized into one of three groups (CBT-I, active control, or one-time brief education control group). One-way ANOVAs were used to assess for group differences and within group change in sleep latency, sleep efficiency (SE), time in bed, total sleep time (TST), wake after sleep onset, variability of SE, and variability of TST. RESULTS CBT-I resulted in an increase in sleep efficiency (SE) and decrease in time in bed (TIB) and variability of SE from the sleep log. The CBT-I group also experienced a decrease in TIB and total sleep time (TST) from actigraphy. The active control group demonstrated an increase in variability of SE from actigraphy. CONCLUSION This study indicates that individuals with MS may experience an improvement in sleep log and actigraphy sleep outcomes following CBT-I, but findings need to be replicated in a larger prospective study. The decrease in TST from actigraphy mirrors results from prior studies.
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Affiliation(s)
- Cierra Williams-Cooke
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Leslie LeSuer
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michelle Drerup
- Sleep Disorders Clinic, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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20
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Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment. Healthcare (Basel) 2021; 9:healthcare9091128. [PMID: 34574901 PMCID: PMC8465276 DOI: 10.3390/healthcare9091128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the relationship between somatic symptom disorder (SSD) and sleep disorders, following three research questions: (1) How are these disorders correlated? (2) What are the comorbidities reported in these patients? and (3) What are the most effective pharmacological and non-pharmacological treatments for both conditions? PubMed, Scopus, OVID, Medline, and ProQuest databases were searched for relevant articles published between 1957–2020. Search terms included “somatic symptoms disorder”, “sleep disorders”, “insomnia”, “somatoform”, “somatization”, “therapeutic”, “psychotherapy”, and alternative, formerly used terms for SSD. Forty papers were finally included in the study. Prevalence of insomnia in SSD patients ranged between 20.4–48%, with this being strongly correlated to somatic symptoms and psychosocial disability. The most relevant comorbidities were generalized anxiety disorder, depression, fatigue, negative mood, substance use, orthorexia, alexithymia, anorexia, weight loss, poor eating habits, and acute stress disorder. Patients receiving antidepressant therapy reported significant improvements in insomnia and somatic symptoms. In terms of non-pharmacological interventions, cognitive-behavioral therapy (CBT) showed improvements in sleep outcomes, while the Specialized Treatment for Severe Bodily Distress Syndromes (STreSS) may represent an additional promising option. Future research could include other medical and psychosocial variables to complete the picture of the relationship between sleep disorders and somatic symptoms.
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21
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Van Looveren E, Bilterys T, Munneke W, Cagnie B, Ickmans K, Mairesse O, Malfliet A, De Baets L, Nijs J, Goubert D, Danneels L, Moens M, Meeus M. The Association between Sleep and Chronic Spinal Pain: A Systematic Review from the Last Decade. J Clin Med 2021; 10:3836. [PMID: 34501283 PMCID: PMC8432009 DOI: 10.3390/jcm10173836] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Chronic spinal pain, including both neck and low back pain, is a common disabling disorder in which sleep problems are frequently reported as a comorbidity. The complex processes of both sleep and chronic pain seem to have overlapping mechanisms, which may explain their often established bidirectional relationship. This systematic review aims to investigate the assumed association between sleep and chronic spinal pain by providing an overview of the literature from the last decade. Eligible studies were obtained by searching four databases (PubMed, Embase, Web of Science, and PsycARTICLES). Articles were found relevant if they included a human adult population and investigated the possible association between sleep parameters and chronic spinal pain. Only studies published after January 2009 were included, as this review aimed to provide an update of a previous literature overview on this topic. The quality of the studies was assessed by risk of bias and level of evidence. A total of twenty-seven studies (6 cohort, 5 case-control, and 16 cross-sectional studies) were included in this systematic review. The methodological quality of these studies was low to moderate. The majority of studies reported weak to moderate evidence for an association between sleep parameters and chronic spinal pain, with more severe pain accompanied by more disturbed sleep. Addressing frequently reported sleep problems in chronic spinal pain patients therefore appears to be a necessary complement to pain management to achieve optimal treatment outcomes.
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Affiliation(s)
- Eveline Van Looveren
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (T.B.); (B.C.); (L.D.); (M.M.)
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (W.M.); (K.I.); (A.M.); (L.D.B.); (J.N.)
- Pain in Motion International Research Group, 1090 Brussels, Belgium;
| | - Thomas Bilterys
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (T.B.); (B.C.); (L.D.); (M.M.)
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (W.M.); (K.I.); (A.M.); (L.D.B.); (J.N.)
- Pain in Motion International Research Group, 1090 Brussels, Belgium;
| | - Wouter Munneke
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (W.M.); (K.I.); (A.M.); (L.D.B.); (J.N.)
| | - Barbara Cagnie
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (T.B.); (B.C.); (L.D.); (M.M.)
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (W.M.); (K.I.); (A.M.); (L.D.B.); (J.N.)
- Pain in Motion International Research Group, 1090 Brussels, Belgium;
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Olivier Mairesse
- Sleep Laboratory and Unit for Chronobiology U78, Brugmann University Hospital, Université Libre de Bruxelles—Vrije Universiteit Brussel, 1020 Brussels, Belgium;
- Brain, Body and Cognition, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (W.M.); (K.I.); (A.M.); (L.D.B.); (J.N.)
- Pain in Motion International Research Group, 1090 Brussels, Belgium;
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (W.M.); (K.I.); (A.M.); (L.D.B.); (J.N.)
- Pain in Motion International Research Group, 1090 Brussels, Belgium;
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (W.M.); (K.I.); (A.M.); (L.D.B.); (J.N.)
- Pain in Motion International Research Group, 1090 Brussels, Belgium;
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- University of Gothenburg Center for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Dorien Goubert
- Pain in Motion International Research Group, 1090 Brussels, Belgium;
| | - Lieven Danneels
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (T.B.); (B.C.); (L.D.); (M.M.)
| | - Maarten Moens
- Department of Neurosurgery and Radiology, University Hospital, 1090 Brussels, Belgium;
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Mira Meeus
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (T.B.); (B.C.); (L.D.); (M.M.)
- Pain in Motion International Research Group, 1090 Brussels, Belgium;
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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22
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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.
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Affiliation(s)
| | - Luisa Ende
- Institut für Psychologie, Technische Universität Chemnitz
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23
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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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24
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Smith MT. Highlighting the possibilities of precision sleep medicine by focusing on sleep-Pain interactions: Basic clinical research and pragmatic trials needed. Sleep Med Rev 2021; 59:101542. [PMID: 34593297 DOI: 10.1016/j.smrv.2021.101542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Michael T Smith
- Johns Hopkins University School of Medicine, Division of Behavioral Medicine, 5510 Nathan Shock Drive, STE 100 Baltimore, MD, 21224, USA
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25
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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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26
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Bean DJ, Horne J, Lee AC, Johnson MH. Pre-sleep cognitive arousal exacerbates sleep disturbance in chronic pain: an exploratory daily diary and actigraphy study. Scand J Pain 2021; 21:724-731. [PMID: 34116586 DOI: 10.1515/sjpain-2020-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/17/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Insomnia is commonly comorbid with chronic pain, and typically leads to worse outcomes. Two factors that could contribute to a cycle of pain and sleeplessness are pre-sleep cognitive arousal (repetitive thought processes) and low mood. This study aimed to examine how pain, sleep disturbance, mood, and pre-sleep cognitive arousal inter-relate, to determine whether low mood or pre-sleep cognitive arousal contribute to a vicious cycle of pain and insomnia. METHODS Forty seven chronic pain patients completed twice daily diary measures and actigraphy for one week. Analyses investigated the temporal and directional relationships between pain intensity, sleep quality, time awake after sleep onset, anhedonic and dysphoric mood, and pre-sleep cognitive arousal. Fluctuations in predictor variables were used to predict outcome variables the following morning using mixed-effects modelling. RESULTS For people with chronic pain, an evening with greater pre-sleep cognitive arousal (relative to normal) led to a night of poorer sleep (measured objectively and subjectively), lower mood in the morning, and a greater misperception of sleep (underestimating sleep). A night of poorer sleep quality led to greater pain the following morning. Fluctuations in pain intensity and depression did not have a significant influence on subsequent sleep. CONCLUSIONS For people with chronic pain, cognitive arousal may be a key variable exacerbating insomnia, which in turn heightens pain. Future studies could target cognitive arousal to assess effects on sleep and pain outcomes.
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Affiliation(s)
- Debbie J Bean
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Juliette Horne
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Arier C Lee
- Department of Epidemiology & Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Malcolm H Johnson
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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27
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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: 62] [Impact Index Per Article: 20.7] [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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28
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Tighe CA, Youk A, Ibrahim SA, Weiner DK, Vina ER, Kwoh CK, Gallagher RM, Bramoweth AD, Hausmann LRM. Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity. PAIN MEDICINE 2021; 21:501-510. [PMID: 31504838 DOI: 10.1093/pm/pnz187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Sleep and pain-related experiences are consistently associated, but the pathways linking these experiences are not well understood. We evaluated whether pain catastrophizing and arthritis self-efficacy mediate the association between sleep disturbance and osteoarthritis (OA) symptom severity in patients with knee OA. METHODS We analyzed cross-sectional baseline data collected from Veterans Affairs (VA) patients enrolled in a clinical trial examining the effectiveness of a positive psychology intervention in managing pain from knee OA. Participants indicated how often in the past two weeks they were bothered by trouble falling asleep, staying asleep, or sleeping too much. We used validated scales to assess the primary outcome (OA symptom severity) and potential mediators (arthritis self-efficacy and pain catastrophizing). To test the proposed mediation model, we used parallel multiple mediation analyses with bootstrapping, controlling for sociodemographic and clinical characteristics with bivariate associations with OA symptom severity. RESULTS The sample included 517 patients (Mage = 64 years, 72.9% male, 52.2% African American). On average, participants reported experiencing sleep disturbance at least several days in the past two weeks (M = 1.41, SD = 1.18) and reported moderate OA symptom severity (M = 48.22, SD = 16.36). More frequent sleep disturbance was associated with higher OA symptom severity directly (b = 3.08, P <0.001) and indirectly, through higher pain catastrophizing (b = 0.60, 95% confidence interval [CI] = 0.20 to 1.11) and lower arthritis self-efficacy (b = 0.84, 95% CI = 0.42 to 1.42). CONCLUSIONS Pain catastrophizing and arthritis self-efficacy partially mediated the association between sleep disturbance and OA symptom severity. Behavioral interventions that address pain catastrophizing and/or self-efficacy may buffer the association between sleep disturbance and OA symptom severity.
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Affiliation(s)
- Caitlan A Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ada Youk
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Said A Ibrahim
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York
| | - Debra K Weiner
- Geriatric Research, Education & Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ernest R Vina
- College of Medicine and University of Arizona Arthritis Center, University of Arizona, Tucson, Arizona
| | - C Kent Kwoh
- College of Medicine and University of Arizona Arthritis Center, University of Arizona, Tucson, Arizona
| | - Rollin M Gallagher
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam D Bramoweth
- VISN 4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Geriatric Research, Education & Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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29
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Yu X, Convoy S, Singh PA, Png C, Yoong CS, Pal P. Early Experience of a Multidisciplinary Group Pain Program with Cognitive Behavioural Strategies, Physiotherapy and Peer Support for Patients with Chronic Noncancer Pain. Pain Manag Nurs 2020; 22:293-301. [PMID: 33250326 DOI: 10.1016/j.pmn.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic non-cancer pain affects about 20% of the population worldwide. The effect of medical treatment in isolation is often limited. A multidisciplinary approach has been strongly advocated to help manage patients' pain more effectively. AIMS The primary purpose was to reduce pain severity, pain interference on patients'daily activities and improve their levels of self-efficacy despite pain. The secondary aim was to evaluate the possible changes in patients' depression, anxiety, and stress symptoms after amultidisciplinary group pain program. The program content and structure were also evaluated. DESIGN This scholarly project used within-subject pre- and post-test design. SETTINGS/SUBJECTS Fifty-six patients were recruited from the project center pain clinic. METHODS An evidence-based eight-hour multidisciplinary group pain program was implemented. Data was collected before and 3 months after the program. INTERVENTIONS The program covered pain physiology, cognitive behavioural strategies, demonstration of various exercises, self-management skills, medication management, and peer support. RESULTS Three months postprogram, there was a statistically significant improvement in patients' pain severity (β = -0.9, 95% CI: -1.73 to -0.14, p = .023) and self-efficacy (β = 5.6, 95% CI: 0.85 to 10.41, p = .023). Pain interference on their daily activities was also significantly reduced (β = -2.0, 95% CI: -2.90 to -0.83, p = .001). Patients provided positive and encouraging feedback about the program. CONCLUSION Initial improvements in patients' ability to cope with pain and to perform daily activities were demonstrated following participation in the brief multidisciplinary group pain program. Future randomized controlled trials are needed to confirm that the results are due to patients' participation in the program.
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Affiliation(s)
- Xia Yu
- Department of Nursing Education, Changi General Hospital, Singapore.
| | - Sean Convoy
- Duke University School of Nursing, Durham, North Carolina
| | | | - Constance Png
- Department of Psychological Medicine, Changi General Hospital, Singapore
| | - Chee Seng Yoong
- Department of Anaesthesia, Changi General Hospital, Singapore
| | - Poonam Pal
- Rehabilitation Service, Changi General Hospital, Singapore
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30
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Song ML, Park KM, Motamedi GK, Cho YW. Cognitive behavioral therapy for insomnia in restless legs syndrome patients. Sleep Med 2020; 74:227-234. [PMID: 32861015 DOI: 10.1016/j.sleep.2020.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the effects of cognitive behavioral therapy for insomnia (CBTI) in patients with Restless Legs Syndrome (RLS). METHODS This is a randomized controlled study. The patients were sequentially selected and randomly assigned to either a CBTI group or a non-CBTI group. A total of 25 RLS patients with comorbid insomnia were recruited from a tertiary university hospital sleep center. Twelve were assigned to the CBTI group, and 13 were assigned to the non-CBTI group. The CBTI group received 4 sessions of behavioral therapy, while the non-CBTI group received one informative session on sleep hygiene. All patients completed sleep and psychiatric-related questionnaires. In addition, each individual completed a one-week sleep log for collecting subjective sleep data and actigraphy for objective sleep data. RESULTS After conducting the CBTI, there were significant improvements in severity of insomnia symptoms, subjective sleep efficiency, total sleep time, latency to sleep onset, wake after sleep onset, objective latency to sleep onset, and anxiety in the CBTI group as compared to the non-CBTI group. The effect of CBTI on sleep-related data was maintained for up to three months. CONCLUSIONS CBTI was effective in RLS patients by improving sleep quality and anxiety symptoms. CBTI may be considered in clinical practice for RLS patients with comorbid insomnia.
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Affiliation(s)
- Mei Ling Song
- College of Nursing, Daegu Health College, Daegu, South Korea; College of Nursing, Keimyung University, Daegu, South Korea
| | - Kyung Min Park
- College of Nursing, Keimyung University, Daegu, South Korea.
| | - Gholam K Motamedi
- Department of Neurology, Georgetown University Hospital, Washington, DC, USA
| | - Yong Won Cho
- Department of Neurology, Keimyung University, School of Medicine, Daegu, South Korea.
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31
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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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32
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Tang NKY, Moore C, Parsons H, Sandhu HK, Patel S, Ellard DR, Nichols VP, Madan J, Collard VEJ, Sharma U, Underwood M. Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study. BMJ Open 2020; 10:e034764. [PMID: 32193269 PMCID: PMC7150590 DOI: 10.1136/bmjopen-2019-034764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To test the feasibility of implementing a brief but intensive hybrid cognitive behavioural therapy (Hybrid CBT) for pain-related insomnia. DESIGN Mixed-methods, with qualitative process evaluation on a two-arm randomised controlled feasibility trial. SETTING Primary care. PARTICIPANTS Twenty-five adult patients with chronic pain and insomnia. INTERVENTION Hybrid CBT or self-help control intervention. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes measures were the Insomnia Severity Index and interference scale of the Brief Pain Inventory (BPI). Secondary outcomes measures were the present pain intensity rating from the BPI, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale and EQ-5D-5L. RESULTS Fourteen participants were randomised to receive Hybrid CBT, 11 to receive the self-help control treatment. Of the 14 in the Hybrid CBT group, 9 (64%) completed all four treatment sessions (4 discontinued due to poor health; 1 due to time constraints). Adherence to the self-help control treatment was not monitored. The total number of participants completing the 12-week and 24-week follow-ups were 12 (6 in each group; Hybrid CBT: 43%; self-help: 55%) and 10 (5 in each group; Hybrid CBT: 36%; self-help: 45%). Based on the data available, candidate outcome measures appeared to be sensitive to changes associated with interventions. Thematic analysis of pre-postintervention interview data revealed satisfaction with treatment content among those who completed the Hybrid CBT, whereas those in the self-help control treatment wanted more contact hours and therapist guidance. Other practical suggestions for improvement included shortening the duration of each treatment session, reducing the amount of assessment paperwork, and minimising the burden of sleep and pain monitoring. CONCLUSION Important lessons were learnt with regard to the infrastructure required to achieve better patient adherence and retention. Based on the qualitative feedback provided by a subset of treatment completers, future trials should also consider lowering the intensity of treatment and streamlining the data collection procedure. TRIAL REGISTRATION NUMBER ISRCTN17294365.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, West Midlands, UK
| | - Corran Moore
- Department of Psychology, University of Leicester, Leicester, Leicestershire, UK
| | - Helen Parsons
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - Harbinder Kaur Sandhu
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - Shilpa Patel
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - David R Ellard
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - Vivien P Nichols
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - Jason Madan
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | | | - Uma Sharma
- Patient Representative, Coventry, West Mindlands, UK
| | - Martin Underwood
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
- University Hospitals of Coventry and Warwickshire, Coventry, West Midlands, UK
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33
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Hosogoshi H, Iwasa K, Fukumori T, Takagishi Y, Takebayashi Y, Adachi T, Oe Y, Tairako Y, Takao Y, Nishie H, Kanie A, Kitahara M, Enomoto K, Ishii H, Shinmei I, Horikoshi M, Shibata M. Pilot study of a basic individualized cognitive behavioral therapy program for chronic pain in Japan. Biopsychosoc Med 2020; 14:6. [PMID: 32175003 PMCID: PMC7063808 DOI: 10.1186/s13030-020-00176-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Chronic pain is a major health problem, and cognitive behavioral therapy (CBT) is its recommended treatment; however, efforts to develop CBT programs for chronic pain and assess their feasibility are remarkably delayed in Asia. Therefore, we conducted this pilot study to develop a basic individualized CBT for chronic pain (CBT-CP) and assessed its feasibility for use in Japan. Methods Our study was an open-labeled before–after trial without a control group conducted cooperatively in five Japanese tertiary care hospitals. Of 24 outpatients, 15, age 20–80, who experienced chronic pain for at least three months were eligible. They underwent an eight-session CBT-CP consisting of relaxation via a breathing method and progressive muscle relaxation, behavioral modification via activity pacing, and cognitive modification via cognitive reconstruction. The EuroQol five-dimensional questionnaire five level (EQ5D-5 L) assessment as the primary outcome and quality of life (QOL), pain severity, disability, catastrophizing, self-efficacy, and depressive symptoms as secondary outcomes were measured using self-administered questionnaires at baseline, post-treatment, and 3-month follow-up. Intention-to-treat analyses were conducted. Results Effect size for EQ5D-5 L score was medium from baseline to post-treatment (Hedge’s g = − 0.72, 90% confidence interval = − 1.38 to − 0.05) and up to the 3-month follow-up (g = − 0.60, CI = − 1.22 to 0.02). Effect sizes for mental and role/social QOL, disability, catastrophizing, self-efficacy, and depressive symptoms were medium to large, although those for pain severity and physical QOL were small. The dropout rate was acceptably low at 14%. No severe adverse events occurred. Conclusion The findings suggest that CBT-CP warrants a randomized controlled trial in Japan. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000020880. Registered on 04 February 2016.
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Affiliation(s)
- Hiroki Hosogoshi
- 1Department of Sociology, Faculty of Sociology, Kansai University, 3-3-35 Yamate-cho, Suita-shi, Osaka, 564-8680 Japan.,2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan
| | - Kazunori Iwasa
- 3Faculty of Education, Shujitsu University, 1-6-1 Nishigawara, Naka-ku, Okayama-shi, Okayama, 703-8516 Japan
| | - Takaki Fukumori
- 4Graduate School of Integrated Arts and Sciences, Tokushima University, 1-1 Minamijosanjima-cho, Tokushima-shi, Tokushima, 770-8502 Japan
| | - Yuriko Takagishi
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,5Department of Psychology, Surugadai University, 698 Azu, Hanno-shi, Saitama, 357-8555 Japan
| | - Yoshitake Takebayashi
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,6Department of Health Risk Communication, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Tomonori Adachi
- 7Pain Management Clinic, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu-shi, Shiga 520-2192 Japan
| | - Yuki Oe
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,8Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611 Japan
| | - Yukino Tairako
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,9Department of Psychology, Meiji Gakuin University, 1-2-37 Shirokanedai, Minato-ku, Tokyo, 108-8636 Japan
| | - Yumiko Takao
- 10Department of Pain Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501 Japan
| | - Hiroyuki Nishie
- 11Anesthesiology and Intensive Care 2, Kawasaki Medical School, 577 Matsushima, Kurashiki-shi, Okayama, 701-0192 Japan
| | - Ayako Kanie
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan
| | - Masaki Kitahara
- 12Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama-shi, Kanagawa 232-0024 Japan
| | - Kiyoka Enomoto
- 13Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita-shi, Osaka, 565-0871 Japan
| | - Hirono Ishii
- 14Counseling Office, Japan Women's University, 1-1-1 Nishiikuta, Tama-ku, Kawasaki-shi, Kanagawa 214-8565 Japan
| | - Issei Shinmei
- 15Department of Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8553 Japan.,TCBT Counseling Office, Cosmos Kichijoji Building 2F, 2-8-4 Kichijojihoncho, Musashino-shi, Tokyo, 180-0004 Japan
| | - Masaru Horikoshi
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan
| | - Masahiko Shibata
- 17Department of Health Science, Naragakuen University, 3-15-1 Nakatomigaoka, Nara-shi, Nara, 631-8524 Japan
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Husak AJ, Bair MJ. Chronic Pain and Sleep Disturbances: A Pragmatic Review of Their Relationships, Comorbidities, and Treatments. PAIN MEDICINE 2020; 21:1142-1152. [DOI: 10.1093/pm/pnz343] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AbstractObjectiveThe objective of this review is to answer three questions: 1) How are chronic pain severity and pain duration affected in patients with chronic pain and sleep disturbances that occur simultaneously? 2) What are common comorbidities and pain-related symptoms seen in patients with chronic pain and sleep disturbances? and 3) What are potentially effective pharmacological and nonpharmacological treatment options for both conditions?MethodsOvid Medline and PubMed were searched. Search terms included sleep wake disorder, chronic pain, fibromyalgia, treatment outcome, psychotherapy, complementary therapies, and therapeutics. Studies that assessed outcomes between individuals with chronic pain and those with concurrent chronic pain and sleep disturbances were included. Randomized controlled clinical trials of treatments for both conditions were included.ResultsSixteen studies indicated that patients with both chronic pain and sleep disturbances have greater pain severity, longer duration of pain, greater disability, and are less physically active than those without sleep disturbances. Patients with both conditions are more likely to have concurrent depression, catastrophizing, anxiety, and suicidal ideation. Thirty-three randomized controlled trials assessed treatment for both chronic pain and sleep disturbances. Pregabalin was the most frequently studied medication, showing improvement in pain and sleep symptoms. Cognitive behavioral therapy for insomnia showed long-term improvement in sleep for patients with chronic pain.ConclusionsIndividuals with chronic pain and sleep disturbances have greater symptom severity, longer duration of symptoms, more disability, and additional comorbidities. Pharmacological and nonpharmacological treatments may be useful in the treatment of concurrent chronic pain and sleep disturbances, but further study is needed.
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Affiliation(s)
- Aubrey J Husak
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew J Bair
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- VA Health Services Research and Development Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Indianapolis, Indiana
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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Luyster FS, Ritterband LM, Sereika SM, Buysse DJ, Wenzel SE, Strollo PJ. Internet-Based Cognitive-Behavioral Therapy for Insomnia in Adults With Asthma: A Pilot Study. Behav Sleep Med 2020; 18:10-22. [PMID: 30252506 PMCID: PMC6433549 DOI: 10.1080/15402002.2018.1518229] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background/Objective: Insomnia is common among adults with asthma and is associated with worse asthma control. Cognitive-behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia with medical comorbidities, but it has not been tested in asthma. The purpose of this study was to assess the feasibility and acceptability of an Internet-based CBT-I intervention, called Sleep Healthy Using the Internet (SHUTi), among adults with asthma and comorbid insomnia, and to gather preliminary efficacy data on changes in insomnia severity, sleep quality, asthma control, and asthma-related quality of life. Methods: A single-group, pretest-posttest design was employed, where all participants completed the SHUTi program. Online questionnaires were completed pre- and postintervention. Individual telephone interviews were conducted after posttreatment data collection to obtain participants' experiences with SHUTi and suggestions for improvement. Results: The sample (N = 23) comprised men and women aged 18-75 years with moderate to severe, not well-controlled asthma, and comorbid insomnia. Nineteen (83%) completed postintervention assessments. Improvements on the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Asthma Control Test, and Asthma Quality of Life Questionnair-Marks were observed at postintervention. Data from the telephone interviews suggest that most participants had a positive experience with SHUTi. Participants suggested incorporating asthma-specific content into future versions of the intervention. Conclusions: Internet-based CBT-I is a potential treatment option for adults with asthma and comorbid insomnia.
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Affiliation(s)
- Faith S. Luyster
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Lee M. Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Susan M. Sereika
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Daniel J. Buysse
- Department of Psychiatry and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sally E. Wenzel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Patrick J. Strollo
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Law EF, Wan Tham S, Aaron RV, Dudeney J, Palermo TM. Hybrid Cognitive-Behavioral Therapy Intervention for Adolescents With Co-Occurring Migraine and Insomnia: A Single-Arm Pilot Trial. Headache 2019; 58:1060-1073. [PMID: 30152164 DOI: 10.1111/head.13355] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate feasibility and acceptability of a hybrid cognitive-behavioral therapy intervention for adolescents with co-occurring migraine and insomnia. BACKGROUND Many youth with chronic migraine have co-occurring insomnia. Little research has been conducted to evaluate behavioral treatments for insomnia in youth with migraine. DESIGN AND METHODS We conducted a single-arm pilot trial to evaluate the feasibility and acceptability of delivering cognitive-behavioral therapy for insomnia to 21 youth (mean age 15.5, standard deviation 1.6) with co-occurring chronic migraine and insomnia. Adolescents completed up to 6 individual treatment sessions over 6 to 12 weeks, and 1 booster session 1 month later. Assessments included a prospective 7-day headache and sleep diary, and self-report measures of insomnia, sleep quality, sleep habits, and activity limitations at pre-treatment, immediate post-treatment, and 3-month follow-up. RESULTS Adolescents demonstrated good treatment adherence and families rated the intervention as highly acceptable. Preliminary analyses indicated improvements from pre-treatment to post-treatment in primary outcomes of headache days (M = 4.7, SD = 2.1 vs M = 2.8, SD = 2.7) and insomnia symptoms (M = 16.9, SD = 5.2 vs M = 9.5, SD = 6.2), which were maintained at 3-month follow-up (M = 2.7, SD = 2.8; M = 9.3, SD = 5.0, respectively). We also found improvements in secondary outcomes of pain-related activity limitations as well as sleep quality, sleep hygiene, and sleep patterns. CONCLUSIONS These preliminary data indicate that hybrid cognitive-behavioral therapy is feasible and acceptable for youth with co-occurring chronic migraine and insomnia. Future randomized controlled trials are needed to test treatment efficacy on migraine, sleep, and functional outcomes. ClinicalTrials.gov Identifier: NCT03137147.
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Affiliation(s)
- Emily F Law
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine & Seattle Children's Hospital, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - See Wan Tham
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine & Seattle Children's Hospital, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Rachel V Aaron
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Joanne Dudeney
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine & Seattle Children's Hospital, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
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Improving pain and sleep in middle-aged and older adults: the promise of behavioral sleep interventions. Pain 2019; 160:529-534. [PMID: 30562269 DOI: 10.1097/j.pain.0000000000001423] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Shaffer KM, Camacho F, Lord HR, Chow PI, Palermo T, Law E, Thorndike FP, Ingersoll KS, Ritterband LM. Do treatment effects of a web-based cognitive behavioral therapy for insomnia intervention differ for users with and without pain interference? A secondary data analysis. J Behav Med 2019; 43:503-510. [PMID: 31152334 DOI: 10.1007/s10865-019-00065-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
Cognitive-behavioral therapy for insomnia (CBT-I) shows treatment benefits among individuals with pain interference; however, effects of Internet-delivered CBT-I for this population are unknown. This secondary analysis used randomized clinical trial data from adults assigned to Internet-delivered CBT-I to compare changes in sleep by pre-intervention pain interference. Participants (N = 151) completed the Insomnia Severity Index (ISI) and sleep diaries [sleep onset latency (SOL); wake after sleep onset (WASO)] at baseline, post-assessment, 6- and 12-month follow-ups. Linear mixed-effects models showed no differences between pain interference groups (no, some, moderate/severe) for changes from baseline to any follow-up timepoint for ISI (p = .72) or WASO (p = .88). There was a small difference in SOL between those reporting some versus no or moderate/severe pain interference (p = .04). Predominantly comparable and sustained treatment benefits for both those with and without pain interference suggest that Internet-delivered CBT-I is promising for delivering accessible care to individuals with comorbid pain and insomnia.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, PO Box 801075, Charlottesville, VA, 22908, USA. .,Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA.
| | - Fabian Camacho
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, PO Box 801075, Charlottesville, VA, 22908, USA
| | - Holly R Lord
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, PO Box 801075, Charlottesville, VA, 22908, USA
| | - Philip I Chow
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, PO Box 801075, Charlottesville, VA, 22908, USA
| | - Tonya Palermo
- Center for Child Health and Development, Seattle Children's Research Institute, Seattle, USA
| | - Emily Law
- Center for Child Health and Development, Seattle Children's Research Institute, Seattle, USA
| | | | - Karen S Ingersoll
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, PO Box 801075, Charlottesville, VA, 22908, USA
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, PO Box 801075, Charlottesville, VA, 22908, USA
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Tang NK, Stella MT, Banks PD, Sandhu HK, Berna C. The effect of opioid therapy on sleep quality in patients with chronic non-malignant pain: A systematic review and exploratory meta-analysis. Sleep Med Rev 2019; 45:105-126. [DOI: 10.1016/j.smrv.2019.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/13/2019] [Accepted: 03/14/2019] [Indexed: 12/21/2022]
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Predictors of Adherence to Psychological Treatment for Insomnia and Pain: Analysis from a Randomized Trial. Clin J Pain 2019; 34:375-382. [PMID: 28915152 DOI: 10.1097/ajp.0000000000000546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Poor adherence to psychological treatment for insomnia is common and limits treatment gains. Very little is known about predictors of adherence among patients with chronic pain, although adherence is theorized to be more critical and more challenging for these patients. This secondary data analysis examines predictors of drop-out and therapy nonattendance in an osteoarthritis population receiving psychological treatment for insomnia and pain. METHODS Data were analyzed from the "Lifestyles" trial, a randomized controlled trial of a 6-week group cognitive behavioral pain coping skills intervention (CBT-P), group cognitive-behavioral therapy for pain and insomnia (CBT-PI), and an education only attention control group (EOC). The current analysis focuses on 122 participants randomized to CBT-PI from 6 primary care clinics. Measures of treatment acceptability, demographics, and symptoms were collected at baseline. Factor analysis was used to clarify the boundaries of these domains, and hierarchical regression was used to examine the incremental predictive power of these patient characteristics on therapy attendance. RESULTS Ratings of treatment acceptability were distinct from demographic and medical variables and baseline symptoms. Treatment acceptability was significantly related to session attendance and drop-out (rs ranging from 0.24 to 0.32) and was also one of the strongest predictors of session attendance (β=0.20; P<0.05). DISCUSSION Perceptions of treatment acceptability early in treatment represent a potentially modifiable target to enhance adherence to psychological treatment for insomnia and pain among patients with chronic pain. This work represents an important step towards understanding how to best maximize sleep treatments for this patient population.
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Ho KKN, Ferreira PH, Pinheiro MB, Aquino Silva D, Miller CB, Grunstein R, Simic M. Sleep interventions for osteoarthritis and spinal pain: a systematic review and meta-analysis of randomized controlled trials. Osteoarthritis Cartilage 2019; 27:196-218. [PMID: 30342087 DOI: 10.1016/j.joca.2018.09.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/11/2018] [Accepted: 09/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine if sleep interventions improve pain and sleep in people with osteoarthritis (OA) and/or spinal pain compared to control/placebo. DESIGN Medline, Embase, AMED, PsycINFO, CENTRAL, CINAHL and PEDro were searched from their inception date to July 2017. Keywords relating to "sleep", "OA", "spinal pain", and "randomized controlled trial (RCT)" were combined. Included RCTs investigated the use of sleep interventions for people with OA and/or spinal pain, and measured at least one sleep and health related outcome. Meta-analyses were performed to pool mean differences for pain and sleep quality. PROSPERO CRD42016036315. RESULTS Of 1445 unique records, 24 studies were included. Sixteen studies included participants with spinal pain, seven with OA, and one included a mixed population. Sleep interventions included established sleep interventions (ESI) [cognitive behavioural therapy (CBT) and pharmacological interventions], and a range of others. Intervention periods ranged from 4 to 10 weeks. Thirteen studies were of moderate to high quality (PEDro ≥ 6/10). Due to high heterogeneity between studies we also performed sub-group and sensitivity analyses. ESI decreased Insomnia Severity Index (ISI) for people with low back pain (LBP) (pooled mean difference: -6.78/28, 95% confidence interval (95% CI): [-9.47, -4.09], I2 = 40%) and OA (-2.41, [-4.19, -0.63], 0%). However ESI decreased pain for people with LBP (pooled mean difference: visual analogue scale (VAS) -12.77/100, 95% CI: [-17.57, -7.97], I2 = 0%), but not OA (-2.32, [-7.18, 2.54], 27%). CONCLUSION ESI appeared to improve sleep and pain for people with LBP, and sleep for people with OA. However more vigorous studies need to be conducted.
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Affiliation(s)
- K K N Ho
- The University of Sydney, Musculoskeletal Research Group, Faculty of Health Sciences, 75 East St, Lidcombe, Sydney, 2141 NSW, Australia.
| | - P H Ferreira
- The University of Sydney, Musculoskeletal Research Group, Faculty of Health Sciences, 75 East St, Lidcombe, Sydney, 2141 NSW, Australia.
| | - M B Pinheiro
- The University of Sydney, Musculoskeletal Research Group, Faculty of Health Sciences, 75 East St, Lidcombe, Sydney, 2141 NSW, Australia.
| | - D Aquino Silva
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Av. Pres. Antônio Carlos, 6627 Pampulha, Belo Horizonte, MG, Brazil.
| | - C B Miller
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney and Sydney Health Partners, 431 Glebe Point Road, Sydney, 2037 NSW, Australia.
| | - R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney and Sydney Health Partners, 431 Glebe Point Road, Sydney, 2037 NSW, Australia.
| | - M Simic
- The University of Sydney, Musculoskeletal Research Group, Faculty of Health Sciences, 75 East St, Lidcombe, Sydney, 2141 NSW, Australia.
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Tang NKY. Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:281-289. [PMID: 28284902 DOI: 10.1016/j.pnpbp.2017.02.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
Abstract
Cognitive Behavioural Therapy (CBT) is a form of evidence-based talking therapy that emphasises the importance of behaviour and conscious thoughts in shaping our emotional experiences. As pain becomes increasingly accepted as not only a sensory but also an emotional experience, success in using CBT to treat emotional disorders has resulted in the incorporation of cognitive-behavioural principles into the management of chronic pain. Outcomes of CBT-informed interdisciplinary pain management programmes are modest at best, despite rapid methodological improvements in trial design and implementation. Whilst the field searches for new treatment directions, a hybrid CBT approach that seeks to simultaneously tackle pain and its comorbidities shows promise in optimising treatment effectiveness and flexibility. This article provides a brief description of the core characteristics of CBT and the transformation this therapeutic model has brought to our understanding and management of chronic pain. Current evidence on efficacy of CBT for chronic pain is then reviewed, followed by a critical consideration of the advantages and disadvantages of the new hybrid treatment approach that conceptualises and treats chronic pain in connection with its comorbidities. Recent progress made in the area of pain and insomnia is highlighted as an example to project therapeutic innovations in the near future.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
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Gee B, Orchard F, Clarke E, Joy A, Clarke T, Reynolds S. The effect of non-pharmacological sleep interventions on depression symptoms: A meta-analysis of randomised controlled trials. Sleep Med Rev 2018; 43:118-128. [PMID: 30579141 DOI: 10.1016/j.smrv.2018.09.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 01/28/2023]
Abstract
Poor sleep is a significant risk factor for depression across the lifespan and sleep problems have been hypothesised to contribute to the onset and maintenance of depression symptoms. However, sleep problems are usually not a direct target of interventions for depression. A range of non-pharmacological treatments can reduce sleep problems but it is unclear whether these interventions also reduce other depression symptoms. The aim of this review was to examine whether non-pharmacological interventions for sleep problems are effective in reducing symptoms of depression. We carried out a systematic search for randomised controlled trials of non-pharmacological sleep interventions that measured depression symptoms as an outcome. Forty-nine trials (n = 5908) were included in a random effects meta-analysis. The pooled standardised mean difference for depression symptoms after treatment for sleep problems was -0.45 (95% CI: -0.55,-0.36). The size of the effect on depression symptoms was moderated by the size of the effect on subjective sleep quality. In studies of participants with mental health problems, sleep interventions had a large effect on depression symptoms (d = -0.81, 95% CI: -1.13,-0.49). The findings indicate that non-pharmacological sleep interventions are effective in reducing the severity of depression, particularly in clinical populations. This suggests that non-pharmacological sleep interventions could be offered as a treatment for depression, potentially improving access to treatment.
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Affiliation(s)
- Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK.
| | - Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | | | - Ansu Joy
- Norfolk and Suffolk NHS Foundation Trust, UK
| | - Tim Clarke
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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Malfliet A, Bilterys T, Van Looveren E, Meeus M, Danneels L, Ickmans K, Cagnie B, Mairesse O, Neu D, Moens M, Goubert D, Kamper SJ, Nijs J. The added value of cognitive behavioral therapy for insomnia to current best evidence physical therapy for chronic spinal pain: protocol of a randomized controlled clinical trial. Braz J Phys Ther 2018; 23:62-70. [PMID: 30389347 DOI: 10.1016/j.bjpt.2018.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Insomnia is a highly prevalent and debilitating comorbidity that is often not addressed in therapy for chronic spinal pain (CSP). Given the close interaction between insomnia and CSP severity and related disability, targeting sleep problems during therapy could improve treatment outcomes in these patients. OBJECTIVE Can cognitive behavioral therapy for insomnia (CBT-I) combined with the modern neuroscience approach (i.e. pain neuroscience education and cognition-targeted exercise therapy) reduce pain and improve sleep, physical activity and function in people with CSP and comorbid insomnia? METHODS Participants: One-hundred-twenty participants with chronic spinal pain and comorbid insomnia Intervention: CBT-I combined with the modern neuroscience approach (experimental) compared to the modern neuroscience approach alone (control). Both interventions start with three sessions of pain neuroscience education, followed by six sessions of CBT-I and nine sessions of cognition-targeted exercise therapy in the experimental group, or 15 sessions of cognition-targeted exercise therapy in the control group. MEASUREMENTS Primary outcome measure: self-reported pain severity (Brief Pain Inventory). SECONDARY OUTCOME MEASURES pain sensitivity (pressure pain thresholds, and online questionnaires), sleep-related outcomes (home-based polysomnography and online questionnaires), physical activity (actigraphy), and function (online questionnaires). Online questionnaires will be completed at baseline, directly post-treatment, and at 3, 6 and 12 months post-treatment. Polysomnography, pressure pain thresholds and actigraphy will be carried out at baseline, post-treatment and at 12 months follow-up. DISCUSSION Findings may provide (1) a novel therapeutic approach for people with CSP and comorbid insomnia to improve pain, sleep, physical activity and function, and (2) new treatment guidelines for professionals. TRIAL REGISTRATION Clinicaltrials.gov NCT03482856 (https://clinicaltrials.gov/ct2/show/NCT03482856).
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Affiliation(s)
- Anneleen Malfliet
- Research Foundation - Flanders (FWO), Brussels, Belgium; Pain in Motion International Research Group(1); Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium.
| | - Thomas Bilterys
- Pain in Motion International Research Group(1); Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| | - Eveline Van Looveren
- Pain in Motion International Research Group(1); Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Kelly Ickmans
- Pain in Motion International Research Group(1); Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Olivier Mairesse
- Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium; Sleep Laboratory and Unit for Chronobiology U78, Brugmann University Hospital, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Daniel Neu
- Sleep Laboratory and Unit for Chronobiology U78, Brugmann University Hospital, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dorien Goubert
- Pain in Motion International Research Group(1); Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Steven J Kamper
- School of Public Health, University of Sydney, Camperdown, Australia; Centre for Pain, Health and Lifestyle, Sydney, Australia(2)
| | - Jo Nijs
- Pain in Motion International Research Group(1); Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels Belgium
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Pain and sleep : A bidirectional relationship. Z Gerontol Geriatr 2018; 51:871-874. [PMID: 30367215 DOI: 10.1007/s00391-018-01461-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
Disturbed sleep and persistent pain are common in old people. Persistent pain has a well proven impact on sleep but the relationship between both phenomena is bidirectional since disturbed sleep affects pain perception by lowering the pain threshold. An optimal disease management takes both phenomena into account.
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Abstract
Sleep and pain share a bidirectional relationship. Therefore, it is important for practitioners managing patients experiencing either sleep and/or pain issues to recognize and understand this complex association from a neurobiological perspective involving neuroanatomic and neurochemical processes. Accounting for the influence of pain on the various aspects of sleep and understanding its impact on various orofacial pain disorders assists in developing a prudent management approach. Screening for sleep disorders benefits practitioners in identifying these individuals. Instituting evidence-based multidisciplinary management strategies using both behavioral and pharmacologic strategies enhances the delivery of appropriate care.
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Affiliation(s)
- Gary D Klasser
- Department of Diagnostic Sciences, Louisiana State University Health Sciences Center, School of Dentistry, 1100 Florida Avenue, Box 140, New Orleans, LA 70119, USA.
| | - Galit Almoznino
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Orofacial Sensory Clinic, Hebrew University-Hadassah School of Dental Medicine, PO Box 91120, Jerusalem, Israel; Division of Big Data, Department of Community Dentistry, Orofacial Sensory Clinic, Hebrew University-Hadassah School of Dental Medicine, PO Box 91120, Jerusalem, Israel
| | - Giulio Fortuna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Pansini, 5, Naples 80131, Italy
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Abstract
PURPOSE OF REVIEW Insomnia is approximately 1.5 times more common in women than in men. To date, research has advanced our knowledge about why women report significantly more sleep problems than men despite not being reflected in objective sleep measures. Precisely understanding the symptomatology and pathological mechanisms underlying sex differences is important for prevention and providing appropriate interventions. RECENT FINDINGS Sex differences found in insomnia goes beyond simple explanations and have been proven to be a complicated interplay of biological, psychological, and social factors that play different roles throughout the life span. This paper will review sex differences in insomnia based on risk factors, mechanisms, and consequences, as well as treatment response. In addition, we will also discuss treatment recommendations when working with female populations at different stages in the life span that may be more vulnerable to insomnia. Future studies utilizing prospective, longitudinal designs are needed to understand the interactions of various factors that can explain existing sex differences in insomnia.
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Affiliation(s)
- Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, South Korea
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - Nayoung Cho
- Department of Psychology, Sungshin Women's University, Seoul, South Korea
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
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Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, Carden KA. Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med 2018; 14:1209-1230. [PMID: 29991438 DOI: 10.5664/jcsm.7228] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of actigraphy. METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of actigraphy, sleep logs, and/or polysomnography. Statistical analyses were performed to determine the clinical significance of using actigraphy as an objective measure of sleep and circadian parameters. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS The literature search resulted in 81 studies that met inclusion criteria; all 81 studies provided data suitable for statistical analyses. These data demonstrate that actigraphy provides consistent objective data that is often unique from patient-reported sleep logs for some sleep parameters in adult and pediatric patients with suspected or diagnosed insomnia, circadian rhythm sleep-wake disorders, sleep-disordered breathing, central disorders of hypersomnolence, and adults with insufficient sleep syndrome. These data also demonstrate that actigraphy is not a reliable measure of periodic limb movements in adult and pediatric patients. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.
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Affiliation(s)
| | | | - Joseph Cheung
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California
| | - Jennifer L Martin
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
| | | | | | - Kelly A Carden
- Saint Thomas Medical Partners-Sleep Specialists, Nashville, Tennessee
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Ramlee F, Afolalu EF, Tang NKY. Do People With Chronic Pain Judge Their Sleep Differently? A Qualitative Study. Behav Sleep Med 2018; 16:259-271. [PMID: 27337439 DOI: 10.1080/15402002.2016.1188393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People with chronic pain often report sleep of "poor quality." However, it is unclear what defines sleep quality and whether their sleep quality judgment is influenced by factors other than sleep. We purposively interviewed 17 participants with and without chronic pain and thematically analyzed their interview transcripts. Four salient criteria for judging sleep quality were (a) memories of night-time sleep disruptions, (b) feelings on waking and cognitive functioning during the day, (c) ability to engage in daytime physical and social activity, and (d) changes in physical symptoms (and pain intensity among participants with chronic pain). Sleep quality judgment is complex and involves retrospective decision making influenced by not only memories of the night but also how we feel and what we do during the day.
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Affiliation(s)
- Fatanah Ramlee
- a Department of Psychology , University of Warwick , Coventry , England
| | - Esther F Afolalu
- a Department of Psychology , University of Warwick , Coventry , England
| | - Nicole K Y Tang
- a Department of Psychology , University of Warwick , Coventry , England
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