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Nonpharmacological treatments of insomnia for long-term painful conditions : a systematic review and meta-analysis of patient-reported outcomes in randomized controlled trials
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Tang, Nicole K. Y., Lereya, Suzet Tanya, Boulton, Hayley, Miller, Michelle A., Wolke, Dieter and Cappuccio, Francesco (2015) Nonpharmacological treatments of insomnia for long-term painful conditions : a systematic review and meta-analysis of patient-reported outcomes in randomized controlled trials. Sleep, 81 (11). doi:10.5665/sleep.5158 ISSN 0161-8105.
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Official URL: http://dx.doi.org/10.5665/sleep.5158
Abstract
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, post-treatment and final follow-up. Methodological details concerning the treatment, participants, and study design were abstracted to guide heterogeneity and subgroup analyses. Eleven RCTs involving 1066 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 post-treatment. 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.
Item Type: | Journal Article | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Science > Psychology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Sleep | ||||
Publisher: | American Academy of Sleep Medicine | ||||
ISSN: | 0161-8105 | ||||
Official Date: | 2015 | ||||
Dates: |
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Volume: | 81 | ||||
Number: | 11 | ||||
DOI: | 10.5665/sleep.5158 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access | ||||
Funder: | University of Warwick Research Development Fund |
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