CBT for Insomnia in Chronic Spinal Pain
Trial question
What is the role of adding CBT-I to best evidence pain management in patients with nonspecific chronic spinal pain and insomnia?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
68.0% female
32.0% male
N = 123
123 patients (84 female, 39 male).
Inclusion criteria: patients with nonspecific chronic spinal pain and insomnia.
Key exclusion criteria: severe underlying sleep disorder; neuropathic pain; chronic widespread pain; pregnancy; history of specific spinal surgery; depression; thoracic pain in absence of neck or low back pain; BMI < 30 kg/m².
Interventions
N=61 CBT-I plus pain management (6 sessions of CBT-I and 12 sessions of best evidence pain management over 14 weeks).
N=62 pain management alone (3 sessions of pain neuroscience education and 15 sessions of cognitive exercise therapy over 14 weeks).
Primary outcome
Mean improvement in pain intensity at 12 months
1.976 points
1.006 points
2.0 points
1.5 points
1.0 points
0.5 points
0.0 points
CBT-I plus pain
management
Pain management
alone
No significant
difference ↔
No significant difference in mean improvement in pain intensity at 12 months (1.976 points vs. 1.006 points; MD 0.97, 95% CI -0.05 to 1.99).
Secondary outcomes
Significantly greater improvement in mean Insomnia Severity Index at 12 months (7.35 points vs. 4.154 points; MD 3.197, 95% CI 1.12 to 5.27).
No significant difference in mean improvement in anxiety at 12 months (2.604 points vs. 1.686 points; MD 0.918, 95% CI -0.31 to 2.15).
No significant difference in mean improvement in depression at 12 months (2.291 points vs. 1.336 points; MD 0.955, 95% CI -0.2 to 2.11).
Conclusion
In patients with nonspecific chronic spinal pain and insomnia, CBT-I plus pain management was not superior to pain management alone with respect to mean improvement in pain intensity at 12 months.
Reference
Anneleen Malfliet, Liesbet De Baets, Thomas Bilterys et al. Cognitive Behavioral Therapy for Insomnia in Pain Management for Nonspecific Chronic Spinal Pain: A Randomized Clinical Trial. JAMA Netw Open. 2024 Aug 1;7(8):e2425856.
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