Nonpharmacological Treatments of Insomnia for Long-Term Painful Conditions: A Systematic Review and Meta-analysis of Patient-Reported Outcomes in Randomized Controlled Trials
Open accessAbstract
STUDY OBJECTIVES: Insomnia is a debilitating comorbidity of chronic pain. This study evaluated the effect of nonpharmacological sleep treatments on patient-reported sleep quality, pain, and well-being in people with long-term cancer and non-cancer (e.g., back pain, arthritis, fibromyalgia) pain conditions. DESIGN: We systematically searched Cochrane CENTRAL, MEDLINE, Embase, and PsychINFO for relevant studies. Search period was set to inception of these databases to March 2014. Studies were included if they were: original randomized controlled trials (RCTs); testing a nonpharmacological intervention; that targets sleep; in adults; with painful health conditions; that has a control group; includes a measure of sleep quality; and at least one other health and well-being outcome. MEASUREMENT AND FINDINGS: Means and standard deviations of sleep quality, pain, fatigue, depression, anxiety, physical and psychological functioning were extracted for the sleep treatment and control groups at baseline, posttreatment and final follow-up. Methodological details concerning the treatment, participants, and study design were abstracted to guide heterogeneity and subgroup analyses. Eleven RCTs involving 1,066 participants (mean age 45-61 years) met the criteria for the meta-analysis. There was no systematic evidence of publication bias. Nonpharmacological sleep treatments in chronic pain patients were associated with a large improvement in sleep quality (standardized mean difference = 0.78, 95% Confidence Interval [0.42, 1.13]; P < 0.001), small reduction in pain (0.18 [0, 0.36] P < 0.05), and moderate improvement in fatigue (0.38 [0.08, 0.69]; P < 0.01) at posttreatment. The effects on sleep quality and fatigue were maintained at follow-up (up to 1 year) when a moderate reduction in depression (0.31, [0.09, 0.53]; P < 0.01) was also observed. Both cancer and non-cancer pain patients benefited from nonpharmacological sleep treatments. Face-to-face treatments achieved better outcomes than those delivered over the phone/internet. CONCLUSIONS: Although the body of evidence was small, nonpharmacological sleep interventions may represent a fruitful avenue for optimizing treatment outcomes in patients with chronic pain. REGISTRATION: PROSPERO registration: CRD42013004131.
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The most promising results for treating sleeping problems comorbid with chronic pain point to cognitive behavioural therapy specific for insomnia.
“The most promising results for treating sleeping problems comorbid with chronic pain points to cognitive behavioural therapy specific for insomnia [38, 39].”
From Is sleep disturbance in patients with chronic pain affected by physical exercise or ACT-based stress management? - A randomized controlled study (2018) · cites this paper as [38]
The Results say most treatment packages incorporated a component of CBT-I, and the Discussion reports that the sleep treatments improved sleep quality in patients with chronic pain. The paper evaluates nonpharmacological interventions as a group, however; it does not establish that CBT-I specifically is the most promising treatment relative to alternatives. The indexed passages provide no page numbers. (LLM, conf=0.82)
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Nonpharmacologic Pain Management in Inflammatory Arthritis
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Schuffelen, J., Maurer, L., & Gieselmann, A. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000547436 · Cited by 8 · see citing works
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Does bedtime matter among patients with chronic pain? A longitudinal comparison study
McHugh, R. K., Edwards, R. R., Ross, E. L., & Jamison, R. N. (2019) · PAIN Reports · doi:10.1097/pr9.0000000000000747 · Cited by 8 · see citing works
- Authors
- Tang, N. K. Y., Lereya, S. T., Boulton, H., Miller, M. A., Wolke, D., & Cappuccio, F. P.
- Affiliations
- University of Warwick (GB)
- Department of Psychology, University of Warwick, Coventry, UK
- Corresponding author
- Tang, Nicole K.Y.
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-11-01
- Volume
- 38
- Issue
- 11
- Pages
- 1751-1764
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC4813361
- OpenAlex
- W1784234967
- Cited by
- 176
- References
- 96
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 14 · 2023: 13 · 2022: 19 · 2021: 27 · 2020: 14 · 2019: 22 · 2018: 16 · 2017: 15 · 2016: 5
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- insomnia, chronic pain, sleep quality, cancer pain, back pain, fibromyalgia, arthritis, fatigue, depression, anxiety, psychological functioning, telephone-delivered intervention, online intervention, face-to-face intervention, patient-reported outcomes, well-being, analgesia, follow-up outcomes, publication bias, subgroup analysis
- MeSH terms
- Anxiety, Depression, Fatigue, Humans, Sleep Initiation and Maintenance Disorders, Neoplasms, Sleep, Time Factors, Randomized Controlled Trials as Topic, Treatment Outcome, Self Report, Chronic Pain
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