Cognitive behavioral therapy for insomnia in patients with chronic pain - A systematic review and meta-analysis of randomized controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 33610967 · doi:10.1016/j.smrv.2021.101460
What was done
Authors conducted a systematic review and meta-analysis across eight electronic databases to evaluate the effectiveness of cognitive behavioral therapy for insomnia (CBT-I) in adults with comorbid insomnia and chronic non-cancer pain. Outcomes analyzed were patient-reported sleep, pain, depressive symptoms, anxiety symptoms, and fatigue. From 6,374 screened records, 14 randomized controlled trials (RCTs) were identified, with 12 RCTs (N = 762 participants) included in the quantitative meta-analysis.
What was found
At post-treatment, CBT-I showed statistically significant improvements in global sleep measures (standardized mean difference [SMD] = 0.89), pain (SMD = 0.20), and depressive symptoms (SMD = 0.44). At follow-up (up to 12 months), significant improvements persisted for sleep (SMD = 0.56). Probabilities of favorable outcomes after CBT-I were 81% (post-treatment) and 71% (follow-up) for sleep improvement, and 58% (post-treatment) and 57% (follow-up) for pain reduction. There were no statistically significant improvements in anxiety symptoms or fatigue at post-treatment or follow-up.
Why it matters
This review demonstrates that targeted behavioral treatment for insomnia in chronic pain patients reliably improves sleep quality and depressive symptoms, though its direct impact on pain intensity is minimal and it does not reliably relieve fatigue or anxiety.
Limits
The total pooled sample size across 12 trials was relatively modest (N = 762). Abstract lacks specific confidence intervals, effect sizes for non-significant outcomes, and heterogeneity metrics. Pain improvements were small and effects on anxiety and fatigue were non-significant.
Cited by
- supports Cognitive Behavioral Therapy for Insomnia (CBT-I) is effective for treating insomnia in people with chronic pain, fibromyalgia, and cancer.