However, such behavioral therapy is not effective in the long-term or as a stand-alone treatment, with medication use returning to pre-treatment levels after about six months, its researchers said.
The study, “Effect of cognitive behavioural therapy on sleep and opioid medication use in adults with fibromyalgia and insomnia,” was published in the Journal of Sleep Research.
Insomnia is thought to affect up to 80% of adults with chronic pain, supporting the idea that the two are bidirectional, meaning one contributes to the other.
Common treatments for chronic pain and insomnia are sedatives (hypnotics) and opioids. However, these medications do not consistently provide long-term relief, and are known to have adverse effects that can include dependence, a risk of an overdose, and heart problems.
Cognitive behavioral therapy for insomnia (CBT‐I) and pain (CBT‐P) are potential non-pharmacological treatments. CBT‐I consists of session that include sleep education, relaxation and cognitive restructuring; CBT-P includes session on pain education, progressive muscle relaxation, activity-rest cycles, and cognitive restructuring.
A clinical trial (NCT02001077) in 113 people with fibromyalgia and insomnia that concluded in 2013 reported that those randomized to a weekly, 50-minute course of CBT‐I or CBT‐P for eight weeks had immediate relief for insomnia — although not pain — shortly after treatment.
The researchers who led this trial re-analyzed its data to investigate if CBT‐I and CBT‐P lower patients’ use of sleeping or opioid medications.
Of the 113 people enrolled, 39 completed eight weeks of CBT-I and 37 an eight-week regimen of CBT-P. The remaining 37 patients were not given either intervention and served as controls.
All were asked to keep a dairy for 14 days at baseline (study start), and again after the end of treatment and at follow-up six months later; these diaries at each time point were used to assess changes in medication use.
At baseline, patients who underwent CBT‐P used sleep medications for an average of nine days every two weeks. Immediately post-treatment, usage dropped to an average of 6.71 days. The same was not true for those in the CBT-I and control groups.
In other words, CBT-P — but not CBT-I — led to a significant reduction in sleep medication use following treatment.
“However, this reduction was not maintained at 6 months. There were no significant main or interaction effects for frequency of opioid use,” the researchers reported.
No other significant effects between treatment interventions and medication use were found.
“Although the large reduction in sleep medication at post‐treatment supports the clinical utility of CBT‐P as a potential pathway for reducing reliance on sleep medications in the short term, the findings suggest this is not an effective long‐term solution,” the researchers wrote.
Rather, the potential for “strong psychological dependence factors” in the use of opioids and sleep medications appear to support a need for “direct intervention,” they said.
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