Effect of cognitive behavioural therapy on sleep and opioid medication use in adults with fibromyalgia and insomnia
Sleep and opioid medications used to treat insomnia and chronic pain are associated with adverse side effects (falls and cognitive disturbance). Although behavioural treatments such as cognitive behavioral therapy for insomnia (CBT‐I) and pain (CBT‐P) improve sleep and clinical pain, their effects o...
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Published in | Journal of sleep research Vol. 29; no. 6; pp. e13020 - n/a |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
01.12.2020
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Subjects | |
Online Access | Get full text |
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Summary: | Sleep and opioid medications used to treat insomnia and chronic pain are associated with adverse side effects (falls and cognitive disturbance). Although behavioural treatments such as cognitive behavioral therapy for insomnia (CBT‐I) and pain (CBT‐P) improve sleep and clinical pain, their effects on sleep and opioid medication use are unclear. In this secondary analysis of published trial data, we investigated whether CBT‐I and CBT‐P reduced reliance on sleep/opioid medication in patients with fibromyalgia and insomnia (FMI). Patients with FMI (n = 113, Mage = 53.0, SD = 10.9) completed 8 weeks of CBT‐I (n = 39), CBT‐P (n = 37) or waitlist control (WLC; n = 37). Participants completed 14 daily diaries at baseline, post‐treatment and 6‐month follow‐up, assessing sleep and opioid medication usage. Multilevel modelling examined group by time effects on days of medication use. A significant interaction revealed CBT‐P reduced the number of days of sleep medication use at post‐treatment, but usage returned to baseline levels at follow‐up. There were no other significant within‐ or between‐group effects. CBT‐P led to immediate reductions in sleep medication usage, despite lack of explicit content regarding sleep medication. CBT‐I and CBT‐P may be ineffective as stand‐alone treatments for altering opioid use in FMI. Future work should explore CBT as an adjunct to other behavioural techniques for opioid reduction. |
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Bibliography: | Funding information Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR055160 and R01AR005160‐S1; PI: CSM). Data were collected as part of clinical trial NCT02001077 Sleep and Pain Interventions (SPIN) at the University of Florida (PI: CSM). ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Author Contributions: A.F.C. conducted statistical analyses. A.F.C., M.B.M., N.N., M.D., J.B., K.M. wrote first manuscript draft. M.B.M. and H.R. performed data coding. C.S.M. received funding for and carried out protocol. All authors revised draft. |
ISSN: | 0962-1105 1365-2869 |
DOI: | 10.1111/jsr.13020 |