Treatment of insomnia within an interdisciplinary pain rehabilitation program: a randomized trial

• Julia R. Craner ^[1] ; Lindsay G. Flegge ^[1] ; Rachel B. Gabelman ^[2]
  1. [1] Mary Free Bed Rehabilitation Hospital, USA
  2. [2] VA Central Ohio Healthcare System, USA
• Localización: International journal of clinical and health psychology, ISSN 1697-2600, Vol. 22, Nº. 2, 2022, págs. 21-30
• Idioma: inglés
• DOI: 10.1016/j.ijchp.2022.100295
• Títulos paralelos:
  • Tratamiento del insomnio mediante un programa interdisciplinario de rehabilitación del dolor: ensayo aleatorizado
• Enlaces
  • Texto completo
• Resumen
  • español

    Antecedentes/Objetivo Investigaciones indican que el nivel de cuidado habitual (UC, por siglas en inglés) de los programas interdisciplinarios de rehabilitación del dolor (IPRP, por siglas en inglés) no abordan suficientemente los problemas del sueño entre personas que padecen dolor crónico comórbido con niveles clínicos de insomnio. La terapia cognitivo-conductual para el insomnio (CBT-I, por siglas en inglés) es una intervención basada en la evidencia. Se investiga la translación de la CBT-I en un IPRP.

    Método Se examinaron los resultados relacionados con insomnio y dolor en adultos que participaban en un IPRP de diez semanas (N = 79) asignados a CBT grupal de cuatro sesiones (IPRP + CBT-I) o nivel de cuidado habitual (IPRP-UC).

    Resultados Los pacientes IPRP + CBT-I mostraron mejoría en síntomas de insomnio al final del estudio en comparación con el comienzo del grupo CBT-I; no hubo diferencias significativas en los resultados de IPRP en relación con la condición de IPRP-UC. Ambos grupos informaron reducciones en insomnio, gravedad del dolor, nivel de interferencia en la vida relacionada con el dolor y estado de ánimo deprimido. Menos de un tercio de los participantes informaron reducciones clínicamente significativas en síntomas de insomnio después de participar en IPRP.

    Conclusiones Se necesitan mayores esfuerzos para trabajar con problemas del sueño en el entorno de los programas de rehabilitación del dolor.

  • English

    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.

• Referencias bibliográficas
  • Amtmann, D., Cook, K. F., Jensen, M. P., Chen, W. H., Choi, S., Revicki, D., Cella, D., Rothrock, N., Keefe, F., Callahan, L., & Lai,...
  • Asih, S., Neblett, R., Mayer, T. G., & Gatchel, R. J. (2014). Does patient-reported insomnia improve in response to interdisciplinary...
  • Bastien, C. H., Vallieres, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research....
  • Craner, J., & Flegge, L. (2021). Insomnia symptoms and chronic pain: Outcomes of an interdisciplinary pain rehabilitation program. Pain...
  • Craner, J., Lake, E., Bancroft, K., & George, L. (2020). Treatment outcomes and mechanisms for an ACT-based 10-week interdisciplinary...
  • Davin, S., Wilt, J., Covington, E., & Scheman, J. (2014). Variability in the relationship between sleep and pain in patients undergoing...
  • Edinger, J. D., & Carney, C. E. (2008). Overcoming insomnia: A cognitive-behavioral therapy approach, therapist guide. Oxford University...
  • Ernstrom, C. (2016). End the insomnia struggle: A step-by-step guide to help you get to sleep and stay asleep. New Harbinger.
  • Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression...
  • Gilliam, W. P., Craner, J. R., Cunningham, J. L., Evans, M. M., Luedke, C. A., Morrison, E. J., . . . Loukianova, L. L. (2018). Longitudinal...
  • Huffman, K. L., Rush, T. E., Fan, Y., Sweis, G. W., Vij, B., Covington, E. C., Scheman, J., & Mathews, M. (2017). Sustained improvements...
  • Koffel, E. A., Koffel, J. B., & Gehrman, P. R. (2015). A meta-analysis of group cognitive behavioral therapy for insomnia. Sleep Medicine...
  • Koffel, E., Amundson, E., & Wisdom, J. P. (2020). Exploring the meaning of cognitive behavioral therapy for patients with chronic pain....
  • Lami, M. J., Martínez, M. P., Miro, E., Sanchez, A. I., Prados, G., Caliz, R., & Vlaeyen, J. W. S. (2018). Efficacy of combined cognitive-behavioral...
  • Mack, J., Craner, J., Heredia, D., Bogucki, O., & Sawchuk, C. (2019, November). Qualitative feedback from a brief cognitive behavioral...
  • Morin, C. M., Belleville, G., Belanger, L., & Ivers, H. (2011). The Insomnia Severity Index: psychometric indicators to detect insomnia...
  • Murphy, J. L., Palyo, S. A., Schmidt, Z. S., Hollrah, L. N., Banou, E., Van Keuren, C. P., & Strigo, I. A. (2021). The resurrection of...
  • Natsky, A., N., Vakulin, A., Chai-Coetzer, C. L., Lack, L., McEvoy, R. D., Lovato, N., . . . Kaambwa, B (2020). Economic evaluation of cognitive...
  • Pigeon, W. R., Moynihan, J., Matteson-Rusby, S., Jungquist, C. R., Xia, Y., Tu, X., & Perlis, M. L. (2012). Comparative effectiveness...
  • Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., & Cella, D. (2011). Item banks for measuring emotional distress...
  • Prados, G., Miro, E., Martínez, M. P., Lami, M. J., & Caliz, R. (2020). Combined cognitive-behavioral therapy for fibromyalgia: Effects...
  • Selvanathan, J., Pham, C., Nagapa, M., Peng, P. W. H., Englasakis, M., Espie, C. A., Morin, C. M., & Chung, F. (2021). Cognitive behavioral...
  • Stanos, S. (2012). Focused review of interdisciplinary pain rehabilitation programs for chronic pain management. Current Pain and Headache...
  • Tang, N. K. Y. (2008). Insomnia co-occurring with chronic pain: Clinical features, interaction, assessments and possible interventions. Reviews...
  • Tang, N. K. Y. (2009). Cognitive-behavioral therapy for sleep abnormalities of chronic pain patients. Current Rheumatology Reports, 11, 451–460....
  • Tang, N. K. Y., Goodchild, C. E., & Salkovskis, P. M. (2012). Hybrid cognitive-behaviour theray for individuals with insomnia and chronic...
  • Titler, M. G. (May 31, 2018). Translation research in practice: An introduction. OJIN: The Online Journal of Issues in Nursing, 23. https://doi.org/10.3912/OJIN.Vol23No02Man01...
  • van der Zweerde, T., Bisdounis, L., Kyle, S. D., Lancee, J., & van Straten, A. (2019). Cognitive behavioral therapy for insomnia: a meta-analysis...
  • Williams, J., Roth, A., Vatthauer, K., & McCrae, C. S. (2013). Cognitive behavioral treatment of insomnia. Chest, 143, 554–565. https://doi.org/10.1378/chest.12-0731.
  • Wilson, K. G., Kowal, J., & Ferguson, E. J. (2016). Clinically important change in insomnia severity after chronic pain rehabilitation....
  • Yang, M., Morin, C. M., Schaefer, K., & Wallenstein, G. V. (2009). Interpreting score differences in the Insomnia Severity Index: Using...