Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: A Randomized Controlled Trial

摘要

This controlled trial aims to analyze the efficacy of cognitive-behavioral therapy for insomnia and pain (CBT-IP) compared to cognitive-behavioral therapy for pain (CBT-P) and usual medical care (UMC) at improving sleep and other clinical manifestations (pain, fatigue, impaired functioning, and emotional distress) in women with fibromyalgia (FM). One hundred and twenty-six patients with FM were randomly assigned to different treatment groups and 113 completed the treatments (38 in the CBT-IP group, 34 in the CBT-P group and 41 in the UMC group) and a number of self-reports at pre-treatment, post-treatment, and 3 months of follow-up. The CBT-IP group showed significant improvements at post-treatment in several sleep variables (i.e., subjective sleep quality, sleep latency, sleep efficiency, and use of sleeping medication) that were not observed in the CBT-P and UMC groups. The CBT-IP and CBT-P groups reported significant improvements at post-treatment in FM impact and self-efficacy for coping with pain; the CBT-IP group reported improvements at follow-up in pain intensity, and the CBT-P reported improvements at post-treatment in pain catastrophizing and pain acceptance. Clinical improvements are also described. The findings revealed differential responses between groups regarding sleep and other adjustment parameters and the CBT-IP group exhibited the best clinical response pattern overall. More research in the area of FM treatment is needed to enhance the efficacy of the CBT and identify which patients are likely to benefit from each modality of CBT.