The study, “Cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in adults with comorbid chronic insomnia and fibromyalgia: Clinical outcomes from the SPIN randomized controlled trial,” was published in the journal SLEEP.
Fibromyalgia is characterized by widespread muscle pain, fatigue, sleep disturbance, and memory and mood issues. Recent studies have shown that insomnia, considered one of the hallmark symptoms of the condition, not only contributes to worse chronic pain, but also seems to promote the development of other painful medical conditions.
Further studies confirmed that cognitive behavioral treatment for insomnia was effective at improving sleep and reducing pain symptoms in patients with fibromyalgia. These findings raised the question of whether cognitive behavioral treatment for pain might also reduce pain in these patients. One study assessed the effectiveness of cognitive behavioral treatment for pain in patients with fibromyalgia. However, the clinical outcomes were not compared with the treatment for insomnia.
The Sleep and Pain Interventions trial (NCT02001077) was designed to test and compare the efficacy of insomnia and pain cognitive behavioral treatments on pain relief and sleep problems in patients with fibromyalgia, compared with a wait list control group.
The trial enrolled a total of 113 patients who were randomly assigned to participate in eight sessions of insomnia treatment (39 patients) or pain treatment (37 patients), or to remain in the control group (37 patients).
The primary objective was to evaluate self-reported sleep onset latency, wake after sleep onset, sleep efficiency, sleep quality, and pain ratings. The study also looked at dysfunctional attitudes about sleep. All parameters were assessed at the beginning of treatment, after treatment, and again at a six-month follow-up.
Data revealed that pain and insomnia treatments improved sleep efficiency and quality, and wake after sleep onset, immediately after treatment and at follow-up in both treatment groups, compared with the control group. The improvements seemed to be stronger in the insomnia treatment group, which was also the only group to experience improved dysfunctional attitudes about sleep. However, neither treatments significantly improved pain and general mood compared with the control group.
The percentage of patients who no longer claimed to have difficulties falling asleep and maintaining sleep was higher for those in the insomnia treatment group immediately after treatment, and for both treatment groups at the six month follow-up compared with the control group.
Although few patients saw their pain reduced by more than 50%, “relative to the waitlist control, both CBT-I and CBT-P prompted clinically meaningful, immediate reductions in pain in about a third of patients that persisted at six-months for CBT-I only,” according to the researchers.
Both insomnia and pain cognitive behavioral treatments “led to improvements in self-reported sleep, with CBT-I prompting greater improvements that were maintained over time. Neither treatment prompted improvements in pain or mood relative to the control group,” wrote the researchers, who encouraged “future research that examines potential temporal effects of treatment on pain, identifies patients most likely to benefit from treatment (e.g., those with more severe levels of pain and mood), studies treatment effects on pain-related worry and coping, and investigates the mechanisms underlying treatment effects.”