Is cognitive behavioural therapy for insomnia effective in treating insomnia and pain in individuals with chronic non-malignant pain?
Bohra MH., Espie CA.
AIM: This paper systematically reviews clinical trials investigating the effectiveness of cognitive behavioural therapy for insomnia and pain in patients with chronic non-malignant pain. METHOD: A systematic search of MEDLINE, PSYCINFO, EMBASE, CINHAL and Cochrane library and register of trials was conducted. RESULTS: Essential components of cognitive behavioural therapy for insomnia were included in all studies except for the cognitive restructuring component, which was not considered an intervention in one study. Interventions were provided by adequately trained clinicians. Significant within-group effect sizes (> 1) were observed in the intervention groups as compared with the control groups. Improvements were noted in sleep latency, sleep efficiency and wake after sleep onset times. Although improvements were noted in pain experienced by the participants, this was not a significant finding. CONCLUSIONS: These clinical trials demonstrate that cognitive behavioural therapy for insomnia is effective as an intervention for insomnia in individuals suffering from chronic non-malignant pain. Although pain and disturbed sleep are linked, cognitive behavioural therapy for insomnia alone may not be an effective solution for addressing chronic non-malignant pain. Trials of cognitive behavioural therapy for insomnia on a variety of chronic pain patients with disturbed sleep and with long-term follow-up are required to ascertain whether cognitive behavioural therapy for insomnia is an effective intervention to reduce pain and to add to increasing evidence that it is an effective intervention for insomnia in the chronic pain population.