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Cognitive behavioral therapy for insomnia in patients with chronic pain-A systematic review and meta-analysis of randomized controlled trials

Selvanathan, Janannii, Pham, Chi, Nagappa, Mahesh, Peng, Philip W.H., Englesakis, Marina, Espie, Colin A., Morin, Charles M., Chung, Frances·2021·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2021.101460

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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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“CBT-I is also effective when insomnia is comorbid with tinnitus (Curtis et al., 2021), chronic pain (Selvanathan et al., 2021), cancer (Gao, Liu, et al., 2022; Squires et al., 2022), sleep apnea (COMISA; Sweetman et al., 2023), and in patients with neurological disorders such as traumatic brain…”
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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: Selvanathan, Janannii
Pham, Chi
Nagappa, Mahesh
Peng, Philip W.H.
Englesakis, Marina
Espie, Colin A.
Morin, Charles M.
Chung, Frances
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2021-12
Volume: 60
Pages: 101460
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2021.101460
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
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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Cognitive behavioral therapy for insomnia in patients with chronic pain-A systematic review and meta-analysis of randomized controlled trials

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