Clinical Trials Logo

Clinical Trial Summary

This study is to evaluate a group-based cognitive behavioral therapy for insomnia (CBT-I) intervention delivered in an interdisciplinary pain rehabilitation program (IPRP) compared to usual care.


Clinical Trial Description

Dual Treatment of Chronic Pain and Insomnia within an Interdisciplinary Pain Rehabilitation Program The aim of this project is to develop a dual treatment model for chronic pain and insomnia by combining evidence-based approaches for each condition, addressing an important gap in the research on and treatment of chronic pain. Insomnia is frequently comorbid among patients with chronic pain. Estimates suggest that 50-80% of patients receiving treatment for chronic pain also report significant insomnia. Patients with comorbid insomnia and chronic pain are at higher risk of negative outcomes compared to individuals without insomnia. More specifically, studies have found that higher levels of insomnia are associated with increased difficulty in reducing opioid use, higher pain intensity, greater functional limitations, lower self-efficacy, higher pain catastrophizing, and more depressive symptoms compared to patients with less severe insomnia. Importantly, for patients with clinically significant insomnia symptoms, insomnia often does not improve to a meaningful extent as a result of chronic pain treatment alone. Accordingly, there is a significant need for dual treatment models that address both chronic pain and insomnia. Cognitive-Behavioral Therapy for Insomnia (CBT-I) CBT-I is viewed as the "gold standard" treatment for clinical insomnia. In this treatment model, insomnia is viewed as originating from varying precipitating events (e.g., illness, life changes, pain symptoms), but maintained through sleep-related behaviors that increase sleep-related arousal, fragment sleep, and condition an association between bed/nighttime and wakefulness. Accordingly, CBT-I uses conditioning principles to decrease pre-sleep arousal and recondition a pattern of rapid, consolidated sleep. The key components of this intervention are sleep restriction therapy (SRT), which limits time in bed initially to the duration of actual sleep per night, and stimulus control (SC), which involves modification of factors that associate bed/nighttime with wakefulness (e.g., time awake in bed, wakeful activities in bed). Several randomized controlled trials (RCTs) have been conducted to evaluate this treatment among patients with insomnia and a variety of comorbid chronic pain conditions.8 When compared to usual care or a waiting list control group, patients assigned to receive CBT-I have reported significantly better improvements in insomnia symptoms. In addition, results indicate that the effects of CBT-I delivered to patients with chronic pain have been maintained or improved over time. Interdisciplinary Pain Rehabilitation and Outcomes for Chronic Pain and Insomnia Interdisciplinary pain rehabilitation programs (IPRPs) are evidence-based treatments for chronic pain. These programs emphasize functional restoration and typically involve physical and occupational therapy, medical visits, and mental health visits. Although these programs typically include sleep hygiene training, research indicates that while patients experience significant gains in improving pain, functioning, and quality of life, IPRPs alone are insufficient for improving clinical insomnia. Hybrid interventions for pain and insomnia have demonstrated successful outcomes for treating sleep disturbance and chronic pain. However, the incorporation of CBT-I into and IPRP has not been previously studied. This gap in research has been previously documented and represents an important area for future study. The Current Study The current study aims to assess the effectiveness of CBT-I within the context of a 10-week outpatient IPRP and evaluate whether participation leads to superior outcomes compared to pain rehabilitation alone. Hypothesis 1: Insomnia severity will be associated with pain-related outcomes among patients presenting for chronic pain treatment. Hypothesis 2: CBT-I participation will be associated with significant improvement in insomnia symptoms. Hypothesis 3: Compared to a waitlist control group, patients who participate in CBT-I will have superior treatment outcomes from a pain rehabilitation program. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT05033418
Study type Interventional
Source Mary Free Bed Rehabilitation Hospital
Contact
Status Completed
Phase N/A
Start date June 6, 2019
Completion date April 27, 2021

See also
  Status Clinical Trial Phase
Completed NCT01659073 - Using Perfusion MRI to Measure the Dynamic Changes in Neural Activation Associated With Caloric Vestibular Stimulation N/A
Completed NCT04385030 - Neurostimulation and Mirror Therapy in Traumatic Brachial Plexus Injury N/A
Active, not recruiting NCT03687762 - Back on Track to Healthy Living Study N/A
Completed NCT04171336 - Animal-assisted Therapy for Children and Adolescents With Chronic Pain N/A
Recruiting NCT03179475 - Targin® for Chronic Pain Management in Patients With Spinal Cord Injury Phase 4
Recruiting NCT03418129 - Neuromodulatory Treatments for Pain Management in TBI N/A
Recruiting NCT03268551 - MEMO-Medical Marijuana and Opioids Study
Recruiting NCT04556890 - Pain and Major Depressive Disorder N/A
Completed NCT00983385 - Evaluation of Effectiveness and Tolerability of Tapentadol Hydrochloride in Subjects With Severe Chronic Low Back Pain Taking Either WHO Step I or Step II Analgesics or no Regular Analgesics Phase 3
Completed NCT04546685 - Virtual Single-Session "Empowered Relief" Group Intervention for Chronic Pain N/A
Recruiting NCT03538444 - Repetitive Transcranial Magnetic Stimulation for Opiate Use Disorder N/A
Completed NCT04010019 - The Facing Pain Study N/A
Completed NCT01939366 - Cebranopadol Efficacy and Safety in Diabetic Patients Suffering From Chronic Pain Caused by Damage to the Nerves Phase 2
Completed NCT03298269 - Behavioral Interventions for Chronic Pain and Opioid-Related Problems N/A
Recruiting NCT04567043 - Treating Opioid Misuse Via Mindfulness-Based Just-in-Time Adaptive Intervention N/A
Recruiting NCT04172272 - The Influence of TAP Block in the Control of Postoperative Pain After Laparotomy for Gynecological Procedures N/A
Recruiting NCT03675386 - Reducing Opioid Use for Chronic Pain Patients Following Surgery N/A
Recruiting NCT03950791 - Single Session Class to Reduce Opioid Use in Chronic Pain N/A
Not yet recruiting NCT05050565 - Psychological Flexibility in Chronic Pain Populations; an Observation- and Validation Study
Recruiting NCT04459104 - Pain, Nutrition and Glycemic Response in Chronic Low Back Pain and Breast Cancer Survivors N/A