1. Internet-delivered cognitive behavioral therapy (CBT) may provide greater immediate improvements in insomnia symptoms compared to applied relaxation.
2. After 6 months post-treatment, both treatment modalities had similar overall improvements in insomnia symptoms in the chronic pain cohort.
Evidence Rating Level: 2 (Good)
Patients with chronic pain often have concurrent symptoms of insomnia. These symptoms of poor sleep may lead to increased pain levels which may in turn worsen sleep. It is well known that cognitive behavioral therapy – insomnia (CBT-I) is an effective treatment option for insomnia. Unfortunately, access to CBT-I therapists may be limited; and therefore a more accessible and cost-effective alternative such as internet-delivered CBTI-I may be warranted. As a result, the objective of the present study was to assess the effectiveness of internet-delivered CBT-I for chronic pain patients.
The present randomized controlled parallel-group study was conducted in Sweden. Patients were selected via the Swedish Quality Registry for Pain Rehabilitation. Patients aged 18-65 years old with moderate to severe insomnia and chronic pain were included. Patients with comorbidities such as psychoses and bipolar disorder were excluded from the study. Participants (n=54) were randomized to either the CBT-I internet treatment or the control treatment of applied relaxation. Treatments lasted no longer than 5 weeks. The primary outcome assessed in the study was improvement in the Insomnia Severity Index (ISI) score after treatment.
Results demonstrated a greater improvement in ISI scores for patients who received internet-delivered CBT-I immediately after treatment. At the 6-month follow-up, there were no differences in the ISI score improvements between the two treatment groups. Although there were improvements in daytime sleepiness, there were no inter-group differences. Furthermore, compliance with the interventions was high in both treatment groups, with no inter-group differences. Despite these findings, this study was limited due to the small study group and lack of objective sleep measures. Nonetheless, this study highlighted the potential for internet-delivered CBT-I as a feasible treatment modality for chronic pain patients suffering from insomnia.
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