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Cognitive behavior therapy for insomnia in patients with chronic spinal pain: a multi-center randomized controlled clinical trial
BACKGROUND AND AIM: Chronic spinal pain (CSP) is a highly prevalent and severely debilitating disorder characterized by tremendous personal and socioeconomic consequences1, long-term sick leave and low quality of life. Conservative and pharmacological strategies for CSP management offer at best modest effect sizes in reducing pain and related disability2-4, urging the need for improved care. Insomnia is closely related to pain severity in people with CSP5 and is recognized as a plausible therapeutic target for a range of chronic conditions, including CSP6,7. Between 53% to 90% of chronic pain patients suffer from a clinically significant degree of insomnia5,8-10. Currently treatments for CSP do not address pain comorbidities like insomnia. However, if left untreated, insomnia represents a barrier for effective CSP management11. Therefore, within the current innovative project we propose examining the added value of cognitive behavioral therapy for insomnia (CBT-I), which is the standard evidence-based care for treating chronic primary insomnia12, to the current best evidence treatment for CSP.
A proof of concept study found that CBT-I was successful in improving sleep and the extent to which pain interfered with daily functioning in patients with CSP7. CBT-I cannot be a standalone treatment for CSP, but should provide an added value to available evidence-based treatment for CSP. Therefore, we propose combining CBT-I with the recently established modern neuroscience approach (pain neuroscience education followed by cognition-targeted exercise therapy)13-15 as the new treatment for CSP. This allows us to build on a previous and successful TBM project and to proceed towards a comprehensive evidence-based conservative intervention for a highly prevalent, costly and debilitating condition. Two pilot trials support the combination of CBT-I with a more pain-focused (cognition-targeted) treatment for chronic pain for CSP. The combined approach was feasible to deliver and produced significant improvements in sleep, disability from pain, pain interference, depression and fatigue11,16. Importantly, the combined intervention appeared to have a strong advantage over more pain-focused (cognition-targeted) treatment alone and modest advantage over CBT-I alone in reducing insomnia severity in chronic pain patients11. The gains in insomnia severity and pain interference were maintained at 1- and 6-months follow-up16.
OBJECTIVE: The primary scientific objective of the study is to examine if CBT-I combined with a modern neuroscience approach (pain neuroscience education followed by cognition-targeted exercise therapy)13-15 is more effective compared to the modern neuroscience approach alone for reducing pain and improving sleep in CSP patients with insomnia. Secondary objectives of the study are to examine if CBT-I combined with the modern neuroscience approach is more effective than the modern neuroscience approach alone for improving physical functioning, sleep beliefs and pain cognitions in CSP patients with insomnia.
2. Henschke N, Ostelo RW, van Tulder MW, et al. Behavioural treatment for chronic low-back pain. The Cochrane database of systematic reviews 2010; (7): Cd002014.
3. Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane database of systematic reviews 2012; 11: Cd007407.
4. Cheung CW, Qiu Q, Choi SW, Moore B, Goucke R, Irwin M. Chronic opioid therapy for chronic non-cancer pain: a review and comparison of treatment guidelines. Pain physician 2014; 17(5): 401-14.
5. Tang NK, Wright KJ, Salkovskis PM. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. Journal of sleep research 2007; 16(1): 85-95.
6. Tang NK, Lereya ST, Boulton H, Miller MA, Wolke D, Cappuccio FP. Nonpharmacological Treatments of Insomnia for Long-Term Painful Conditions: A Systematic Review and Meta-analysis of Patient-Reported Outcomes in Randomized Controlled Trials. Sleep 2015; 38(11): 1751-64.
7. Jungquist CR, O'Brien C, Matteson-Rusby S, et al. The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain. Sleep medicine 2010; 11(3): 302-9.
8. Becker N, Bondegaard Thomsen A, Olsen AK, Sjogren P, Bech P, Eriksen J. Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center. Pain 1997; 73(3): 393-400.
9. McCracken LM, Iverson GL. Disrupted sleep patterns and daily functioning in patients with chronic pain. Pain research & management 2002; 7(2): 75-9.
10. Daly-Eichenhardt A, Scott W, Howard-Jones M, Nicolaou T, McCracken LM. Changes in Sleep Problems and Psychological Flexibility following Interdisciplinary Acceptance and Commitment Therapy for Chronic Pain: An Observational Cohort Study. Frontiers in psychology 2016; 7: 1326.
11. Pigeon WR, Moynihan J, Matteson-Rusby S, et al. Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: a pilot study. Behaviour research and therapy 2012; 50(11): 685-9.
12. Finan PH, Buenaver LF, Coryell VT, Smith MT. Cognitive-Behavioral Therapy for Comorbid Insomnia and Chronic Pain. Sleep medicine clinics 2014; 9(2): 261-74.
13. Nijs J, Meeus M, Cagnie B, et al. A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training. Physical therapy 2014; 94(5): 730-8.
14. Nijs J, Lluch Girbes E, Lundberg M, Malfliet A, Sterling M. Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories. Manual therapy 2015; 20(1): 216-20.
15. Dolphens M, Nijs J, Cagnie B, et al. Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial. BMC musculoskeletal disorders 2014; 15: 149.
16. Tang NK, Goodchild CE, Salkovskis PM. Hybrid cognitive-behaviour therapy for individuals with insomnia and chronic pain: a pilot randomised controlled trial. Behaviour research and therapy 2012; 50(12): 814-21.