Chronic Pain and Sleep Disturbances: A Pragmatic Review of Their Relationships, Comorbidities, and Treatments

Pain Medicine ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 1142-1152
Author(s):  
Aubrey J Husak ◽  
Matthew J Bair
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbances ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Pain Severity ◽  
Physically Active ◽  
Duration Of Symptoms ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Pain Duration

Abstract Objective The objective of this review is to answer three questions: 1) How are chronic pain severity and pain duration affected in patients with chronic pain and sleep disturbances that occur simultaneously? 2) What are common comorbidities and pain-related symptoms seen in patients with chronic pain and sleep disturbances? and 3) What are potentially effective pharmacological and nonpharmacological treatment options for both conditions? Methods Ovid Medline and PubMed were searched. Search terms included sleep wake disorder, chronic pain, fibromyalgia, treatment outcome, psychotherapy, complementary therapies, and therapeutics. Studies that assessed outcomes between individuals with chronic pain and those with concurrent chronic pain and sleep disturbances were included. Randomized controlled clinical trials of treatments for both conditions were included. Results Sixteen studies indicated that patients with both chronic pain and sleep disturbances have greater pain severity, longer duration of pain, greater disability, and are less physically active than those without sleep disturbances. Patients with both conditions are more likely to have concurrent depression, catastrophizing, anxiety, and suicidal ideation. Thirty-three randomized controlled trials assessed treatment for both chronic pain and sleep disturbances. Pregabalin was the most frequently studied medication, showing improvement in pain and sleep symptoms. Cognitive behavioral therapy for insomnia showed long-term improvement in sleep for patients with chronic pain. Conclusions Individuals with chronic pain and sleep disturbances have greater symptom severity, longer duration of symptoms, more disability, and additional comorbidities. Pharmacological and nonpharmacological treatments may be useful in the treatment of concurrent chronic pain and sleep disturbances, but further study is needed.

scholarly journals Mindfulness-based cognitive therapy and cognitive behavioral therapy for chronic pain in multiple sclerosis: a randomized controlled trial protocol

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Dawn M. Ehde ◽  
Kevin N. Alschuler ◽  
Melissa A. Day ◽  
Marcia A. Ciol ◽  
Makena L. Kaylor ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Usual Care ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Average Pain Intensity ◽  
Average Pain ◽  
Pre Treatment ◽  
Management Approaches

Abstract Background Chronic pain is one of the most prevalent and disabling symptoms associated with multiple sclerosis (MS). Individuals with MS are interested in nonpharmacologic pain management approaches. Cognitive-behavioral therapy (CBT) is efficacious in improving MS-related pain outcomes. Mindfulness-based cognitive therapy (MBCT) is a promising, alternative approach. Little is known about moderators of these treatments’ outcomes, however. This article describes the study protocol for the first randomized controlled trial comparing MBCT, CBT, and usual care and examining treatment effect moderators in individuals with chronic pain and MS. Methods We will conduct a single-center, randomized, single blind, parallel-group trial comparing MBCT, CBT, and usual care in adults with MS and chronic pain. Both interventions will be delivered via eight group sessions using videoconferencing technology. Primary (average pain intensity) and secondary outcomes (including pain interference, depressive symptoms, fatigue, and sleep) will be assessed pre-treatment, mid-treatment, post-treatment, and at 6-month follow up. Potential treatment moderators will be assessed pre-treatment. We hypothesize that participants randomly assigned to MBCT or CBT will report significantly greater reductions in average pain intensity than participants assigned to usual care at post-treatment (primary study endpoint) and 6-month follow up. We also hypothesize that mindfulness, pain catastrophizing, and behavioral activation pre-treatment will moderate response to both active treatments, but not response to usual care. Discussion Findings will provide important new information about the efficacy and moderators of two nonpharmacologic pain management approaches delivered using technology to overcome common barriers to treatment access. The knowledge gained may lead to better patient-treatment matching and, ultimately, better pain treatment outcomes in MS. Trial registration ClinicalTrials.gov, NCT03782246. Registered on 20 December 2018.

Comorbidity of Migraine and Epilepsy in Pediatrics: A Review

2018 ◽  
Vol 33 (12) ◽  
pp. 801-808 ◽  
Author(s):  
Jasna Jancic ◽  
Vesna Djuric ◽  
Boris Hencic ◽  
John N. van den Anker ◽  
Janko Samardzic
Keyword(s):  
Genetic Basis ◽  
Treatment Options ◽  
Dietary Therapy ◽  
Channel Blockers ◽  
Therapeutic Approaches ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
New Therapeutic Approaches ◽  
Neurologic Disorders

Migraine and epilepsy are classified as chronic paroxysmal neurologic disorders sharing many clinical features, as well as possible treatment options. This review highlights the similarities between migraine and epilepsy in pediatrics, focusing on epidemiologic, pathophysiological, genetic, clinical, and pharmacologic aspects. Despite the fact that several syndromes share symptoms of both migraine and epilepsy, further research is needed to clarify the pathophysiological and genetic basis of their comorbidity. Drugs used for prophylactic therapy of migraine and epilepsy have similar pharmacologic properties. The role of epileptic pharmacotherapy in the prophylaxis of migraine is assessed, including the use of conventional antiepileptic drugs, calcium channel blockers, and nonpharmacologic methods such as dietary therapy, supplements, and vagal nerve stimulation. Further randomized, controlled clinical trials assessing pharmacologic and nonpharmacologic methods for the treatment of both disorders are essential, in order to initiate new therapeutic approaches.

scholarly journals Developing and Testing the Effectiveness of a Novel Online Integrated Treatment for Problem Gambling and Tobacco Smoking: A Protocol for a Randomized Controlled Trial

2020 ◽  
Author(s):  
Elena Bilevicius ◽  
Alanna Single ◽  
Chris Baumgartner ◽  
Van Bui ◽  
Tyler Kempe ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Problem Gambling ◽  
Tobacco Smoking ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Treatment Options ◽  
Integrated Treatment ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Gambling Activities

Abstract Background: Gambling and tobacco smoking are highly comorbid among North American adults. However, there is a paucity of treatment options that are integrated (i.e., targeting both gambling and tobacco smoking simultaneously), accessible, and evidence based.Methods: The aim of this two-arm randomized controlled trial is to examine the effectiveness of an online, self-guided integrated treatment for problem gambling and tobacco smoking. A target sample of 214 participants will be recruited and be randomized into either an eight-week integrated or gambling-only control condition. Both conditions will consist of seven online modules following cognitive behavioral therapy and motivational interviewing principles. Our three primary outcomes are (1) number of days gambled, (2) money spent on gambling activities, and (3) time spent in gambling activities. Secondary outcomes include gambling disorder symptoms, cigarette use, and nicotine dependence symptoms. Assessments will be completed at baseline, at completion (i.e., eight-weeks from baseline), and follow-up (i.e., 24-weeks from baseline). Generalized linear mixed modelling will be used to evaluate our primary and secondary outcomes. We expect that participants receiving online integrated treatment will show larger reductions in gambling relative to those receiving a control gambling only intervention. We further hypothesize that reductions in smoking will mediate these group differences.Discussion: The rates of problem gambling and tobacco smoking are high in North America; yet, the treatment options for both are limited, with no integrated treatments available. If supported, our intervention will be a cost-effective and accessible way to improve treatments for co-occurring problem gambling and tobacco use.Trial registration: Clinicaltrials.gov; ID NCT03614884. Registered August 3, 2019;

e-Health Interventions for Physical Symptom Control

2021 ◽  
pp. 550-560
Author(s):  
Robert Zachariae
Keyword(s):  
Cancer Patients ◽  
Sleep Disturbances ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Symptom Control ◽  
Physical Symptom ◽  
Convincing Evidence ◽  
Web Based ◽  
Cancer Related Fatigue ◽  
Highly Correlated

Persistent pain, fatigue, and sleep disturbances are prevalent and distressing physical and biobehavioral symptoms and late effects experienced by many cancer patients and survivors. While effective pharmacological treatment options are limited, a growing body of evidence points to the potential efficacy of nonpharmacological approaches, including psychoeducation, physical exercise, and cognitive-behavioral therapy (CBT). There are, however, considerable challenges in making such interventions available and accessible to those in need. Delivering interventions remotely using e-health solutions may be one way of overcoming these barriers. Of the available randomized controlled trials, the majority have focused on web-based interventions for cancer-related fatigue (CRF), with the most convincing evidence found for web-based CBT for insomnia (eCBT-I) and e-health-supported exercise programs. Despite few trials with cancer patients and survivors, given the evidence for the efficacy of web-based CBT-I for noncancer samples and for face-to-face-delivered CBT-I with this group, eCBT-I is a highly promising intervention for cancer-related sleep disturbances. Currently, the weakest evidence is found for pain, but it is of interest to note the preliminary findings of highly correlated improvements in co-occurring symptoms of CRF and pain, and sleep disturbance and CRF. Several questions remain to be answered, including which patients the interventions will work best for and whether there are adverse effects associated with e-health delivery. However, together with increasing internet and smartphone penetration rates, the available evidence points to the relevance of further research in e-health solutions for physical symptom management in cancer patients and survivors.

scholarly journals Pharmacologic Treatment Options for Insomnia in Patients with Schizophrenia

Medicines ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 88 ◽  
Author(s):  
Lauren Stummer ◽  
Marija Markovic ◽  
Megan Maroney
Keyword(s):  
Sleep Disturbances ◽  
Literature Search ◽  
Treatment Options ◽  
Sodium Oxybate ◽  
Controlled Trials ◽  
Evidence Based ◽  
Pharmacologic Treatment ◽  
Search Results ◽  
Randomized Controlled ◽  
Second Generation Antipsychotic

Background: Symptoms of sleep disorders, such as disturbances in sleep initiation and continuity, are commonly reported in patients with schizophrenia, especially in the acute phase of illness. Studies have shown that up to 80% of patients diagnosed with schizophrenia report symptoms of insomnia. Sleep disturbances have been shown to increase the risk of cognitive dysfunction and relapse in patients with schizophrenia. Currently, there are no medications approved specifically for the treatment of insomnia in patients with schizophrenia. Methods: A literature search was performed through OVID and PubMed to compile publications of pharmacotherapy options studied to treat insomnia in patients with schizophrenia. Articles were reviewed from 1 January 2000 through 1 March 2018 with some additional earlier articles selected if deemed by the authors to be particularly relevant. Results: Pharmacotherapies collected from the search results that were reviewed and evaluated included melatonin, eszopiclone, sodium oxybate, and antipsychotics. Conclusions: Overall, this review confirmed that there are a few evidence-based options to treat insomnia in patients with schizophrenia, including selecting a more sedating second-generation antipsychotic such as paliperidone, or adding melatonin or eszopiclone. Further randomized controlled trials are needed.

scholarly journals Randomized controlled trial on the effect of Internet-based Cognitive Behavioral Therapy with Real-Time Therapist Support Via a Video Conference for patients with chronic pain: A study protocol

2020 ◽  
Author(s):  
Kayoko Taguchi ◽  
Noriko Numata ◽  
Kana Kutsuzawa ◽  
Kensuke Yoshimura ◽  
Eiji Shimizu
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Usual Care ◽  
Real Time ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Video Conference ◽  
Randomized Controlled ◽  
Therapist Support

Abstract Background: Chronic pain, which persists for at least 12 weeks, is a serious medical condition that not only causes numerous physical and mental conditions, but also affects a person's entire life. Previous studies concerning cognitive behavioral therapy for patients with chronic pain have shown low to intermediate effectiveness. This paper describes the study protocol for a randomized controlled trial (RCT) to evaluate the effectiveness of our newly developed Internet-based Cognitive Behavioral Therapy with Real-Time Therapist Support Via a Video Conference (vCBT) as an adjunct to usual care compared with only usual care for chronic pain. Methods: The RCT comprises two parallel groups (vCBT + usual care and usual care alone) of 20 participants each (n=40) who were diagnosed with chronic pain. We aim to evaluate the effectiveness of the intervention over 16 weeks. The primary outcome is pain intensity, which will be assessed by the Numerical Rating Scale (NRS) at week 16. Secondary outcomes are pain catastrophic perception and daily life impairment degree, each assessed by the Pain Catastrophizing Scale (PCS) and Pain Disability Assessment Scale (PADS). In addition, anxiety, depression, and quality of life will be assessed. All measures will be assessed at weeks 1 (baseline), 8 (middle), and 16 (post). Discussion: This study aims to demonstrate the effectiveness of Internet-based CBT with Real-Time Therapist Support Via a Video Conference for patients with chronic pain. The findings of this study will show a feasibility and safety of online CBT for chronic pain, valuable addition to the treatment options for these patients. And we expect that many therapists will be able to universally provide CBT of comparable quality in the treatment of chronic pain by using the CBT protocol which we have developed.

scholarly journals Rumination-Focused Cognitive-Behavioral Therapy for Chronic Low Back Pain: A Randomized Controlled Trial

2020 ◽  
Vol 9 ◽  
Author(s):  
Ali Soleymani ◽  
Abbas Masjedi Arani ◽  
Seyed Ahmad Raeissadat ◽  
Mohammad Hassan Davazdahemami
Keyword(s):  
Chronic Pain ◽  
Randomized Controlled Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Low Back ◽  
Randomized Controlled

Background: Chronic pain remains or reappears for more than 3 to 6 months, and it is influencing 20% of the global population. The pain catastrophizing affects pain intensity and psychological conditions of patients with chronic pain. Rumination-focused cognitive-behavioral therapy (RFCBT) targets rumination as the key component of pain catastrophizing. The aim of this study was to determine the effectiveness of RFCBT on depression, anxiety, and pain severity of individuals with chronic low back pain (LBP). Materials and Methods: In a randomized controlled trial, 30 patients aged between 20-55 years with diagnosed chronic LBP were chosen by convenience sampling and randomly allocated into intervention and control groups. All patients used their prescribed medications for pain management, but the intervention group received 12 weekly sessions of RFCBT, which was manualized psychotherapy to change unconstructive rumination to constructive rumination. Depression Anxiety and Stress scale-21 and chronic pain grade questionnaire were administered as pre-tests and re-administered after 3 and 6 months as post-test and follow-up assessments, respectively. Results: RFCBT significantly reduced depression (F1=23.01, P=0.001), anxiety (F1=25.7, P=0.001) and pain severity (F1=7.17, P=0.012) in patients with chronic LBP. Conclusion: RFCBT may offer benefits for treating patients with chronic low back pain when added to their usual pharmacological treatment. This benefit may be the result of targeting rumination as the key element of pain catastrophizing. [GMJ.2020;9:e1722]

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