Does a Multidisciplinary Pain Management Treatment Improve Sleep Quality in Patients with Chronic Widespread Pain and Sleep Problems? Results from the AMS-Pain Cohort

Abstract

Background: Poor sleep quality is a significant concern for patients with chronic widespread pain (CWP), impacting their emotional, cognitive, and physical well-being. While there is little specific attention given to the treatment of sleep in such programs, it is possible that its ingredients, such as cognitive behavioral therapy, improving body awareness, relaxation, having a balanced daily routine, and physical activity, have a positive effect on sleep. The objectives of this study are to examine: 1. whether sleep improves after a multidisciplinary pain management treatment. 2. and to explore predictors of treatment outcome, in patients with chronic widespread pain (CWP) and sleep problems. Methods: Data were used from pre- and post-treatment measurements of 121 patients with CWP and sleep problems, treated with a multidisciplinary pain management treatment (not specifically focusing on sleep). Mean difference in subjective sleep quality and standard outcome of multidisciplinary treatment, as measured with Pittsburg Sleep Quality Index (PSQI) and IMMPACT outcome measures, were analyzed and Cohens d were calculated. Regression models were used to assess whether pretreatment variables predicted poor improvement of subjective sleep quality post treatment. Results: The effect size of improvement in sleep quality was small (Cohen’s d=0.3) and 94% of the patients still experienced poor sleep quality after treatment (PSQI ≥ 6). Moderate effects sizes were found for pain (d=0.6), fatigue (d=0.56) and disability (d=0.53). Pretreatment poorer sleep quality, higher levels of pain related disability, psychological distress and less concern predicted poorer sleep quality post-treatment. Conclusion: The improvement of sleep quality after following a multidisciplinary pain management treatment not specifically focusing on sleep was limited. To improve sleep, specific strategies targeting sleep (e.g., sleep education, sleep hygiene and /or cognitive behavioral therapy for sleep) may need to be included into multidisciplinary treatment. Addressing pain related disability and psychological distress, may also help to improve sleep quality.