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Cognitive behavioral therapy for insomnia in patients with chronic pain-A systematic review and meta-analysis of randomized controlled trials
Abstract
Several randomized controlled trials have implemented cognitive behavioral therapy for insomnia (CBT-I) for patients with comorbid insomnia and chronic pain. This systematic review and meta-analysis investigated the effectiveness of CBT-I on patient-reported sleep, pain, and other health outcomes (depressive symptoms, anxiety symptoms, and fatigue) in patients with comorbid insomnia and chronic non-cancer pain. A systematic literature search was conducted using eight electronic databases. Upon duplicate removal, 6374 records were screened against the inclusion criteria. Fourteen randomized controlled trials were selected for the review, with twelve (N = 762 participants) included in the meta-analysis. At post-treatment, significant treatment effects were found on global measures of sleep (standardized mean difference = 0.89), pain (0.20), and depressive symptoms (0.44). At follow-up (up to 12 mo), CBT-I significantly improved sleep (0.56). Using global measures of sleep, we found a probability of 81% and 71% for having better sleep after CBT-I at post-treatment and final follow-up, respectively. The probability of having less pain after CBT-I at post-treatment and final follow-up was 58% and 57%, respectively. There were no statistically significant effects on anxiety symptoms and fatigue at either assessment point. Future trials with sufficient power, longer follow-up periods, and inclusion of CBT for pain components are warranted.
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“Improving sleep has also been shown to improve aspects of physical health, including fatigue [81], chronic pain [82,83], and overall health related quality of life [84]”
From Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials (2021) · cites this paper as [82]
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Is cognitive-behaviour therapy for insomnia (CBT-I) the new best pain killer?
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Management of patients with insomnia and polymorbidity. A draft of the clinical guidelines
Poluektov, M. G., Akarachkova, E. S., Dovgan, E. V., Котова, О. В., Demidova, T. Y., Клименко, А. А., Kokorin, K. V. A., Ostroumova, O. D., & Оstroumova, Т. М. (2024) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202412405239 · Cited by 3
Metadata
- Authors
- Selvanathan, J., Pham, C., Nagappa, M., Peng, P. W. H., Englesakis, M., Espie, C. A., Morin, C. M., & Chung, F.
- Affiliations
- University Health Network (CA)
- Western University (CA)
- University of Oxford (GB)
- Université Laval (CA)
- Corresponding author
- Chung, Frances
- ORCID
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 60
- Pages
- 101460
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W3128925023
- Semantic Scholar
- 34abe2fe5cf170d4406cc51fb99f549a0d1a6067
- Cited by
- 206
- References
- 85
- Citations by year
- 2026: 35 · 2025: 47 · 2024: 35 · 2023: 44 · 2022: 31 · 2021: 13
- FWCI
- 5.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- cognitive behavioral therapy for insomnia, insomnia, chronic non-cancer pain, sleep quality, pain intensity, depressive symptoms, anxiety symptoms, fatigue, treatment effectiveness
- MeSH terms
- Analgesics, Opioid, Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Chronic Pain
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