Abstract
Sleep problems are common and may be associated with persistent pain. It is unclear whether non-pharmacological interventions improve sleep and pain in adults with comorbid sleep problems and musculoskeletal (MSK) pain. We conducted a systematic review on the effectiveness of non-pharmacological interventions on sleep characteristics among adults with MSK pain and comorbid sleep problems. We searched MEDLINE, EMBASE, CINAHL, Cochrane Central and PsycINFO from inception to April 2, 2021 for randomized controlled trials (RCTs), cohort, and case-control studies. Pairs of independent reviewers critically appraised and extracted data from eligible studies. We synthesized the findings qualitatively. We screened 8459 records and identified two RCTs (six articles, 467 participants). At 9 months, in adults with insomnia and osteoarthritis pain, cognitive behavioral therapy for pain and insomnia (CBT-PI) was effective at improving sleep (Insomnia Severity Index, ISI) when compared to education (OR 2.20, 95% CI 1.25, 3.90) or CBT for pain (CBT-P) (OR 3.21, 95% CI 1.22, 8.43). CBP-P vs. education was effective at increasing sleep efficiency (wrist actigraphy) in a subgroup of participants with severe pain at baseline (mean difference 5.45, 95% CI 1.56, 9.33). At 18 months, CBT-PI, CBT-P and education had similar effectiveness on sleep and pain or health outcomes. In adults with insomnia and knee osteoarthritis, CBT-I improved some sleep outcomes including sleep efficiency (diary) at 3 months (Cohen’s d 0.39, 95% CI 0.24, 1.18), and self-reported sleep quality (ISI) at 6 months (Cohen’s d − 0.62, 95% CI -1.01, − 0.07). The intervention was no better than placebo (behavioural desensitization) for improving other sleep outcomes related to sleep onset or pain outcomes. Short-term improvement in sleep was associated with pain reduction at 6 months (WOMAC pain subscale) (sensitivity 54.8%, specificity 81.4%). Overall, in two acceptable quality RCTs of adults with OA and comorbid insomnia, CBT-PI/I may improve some sleep outcomes in the short term, but not pain outcomes in the short or long-term. Clinically significant improvements in sleep in the short term may improve longer term pain outcomes. Further high-quality research is needed to evaluate other non-pharmacological interventions for people with comorbid sleep problems and a range of MSK conditions.
Highlights
Musculoskeletal (MSK) conditions are leading causes of disability worldwide [1]
We did not identify any eligible cohort or case-control studies. Study characteristics Both randomized controlled trials (RCTs) were conducted in the U.S and comprised of participants with OA pain and insomnia (Table 1) [31, 32, 36, 41,42,43]
The Education only control (EOC) was designed as an attention control, and included educational content related to sleep and pain management; classes were facilitated in a nondirective, self-help format that did not include homework assignments, guided practice in CBT principles, or daily behavioral self-monitoring
Summary
Musculoskeletal (MSK) conditions are leading causes of disability worldwide [1]. MSK conditions are the most common causes of severe long-term pain and are typically characterized by limitations in mobility, dexterity and functional ability affecting social functioning and mental health, further diminishing overall quality of life [1]. Sleep disturbances include poor quality sleep, reduced sleep efficiency and duration, delayed sleep onset, fragmentation of sleep architecture or sleep continuity, increased activity or movement during sleep, nonrestorative sleep and increased sleepiness during daytime [3, 4] Sleep problems, such as insomnia and poor sleep quality are amongst the most common comorbidities associated with various MSK conditions [5,6,7,8]. While chronic pain and chronic insomnia exacerbate profound negative consequences individually, when they cooccur, their combined impact in lost productivity and personal suffering is magnified Compared to those experiencing only chronic pain, those that experience both chronic pain and difficulties with sleep report higher pain intensity, more depressive symptoms, and greater distress [2, 12,13,14,15]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
