Treatment of Insomnia Secondary to Chronic Pain

描述（由申请人提供）：慢性疼痛影响着4000万至7000万人，其中近90%的人经历过睡眠障碍。虽然与慢性疼痛相关的失眠与原发性失眠具有相同的病因学因素似乎是合理的，但关于失眠的认知行为疗法（CBT-I）是否能成功应用于慢性疼痛继发失眠的研究很少。我们建议解决这个问题，并进一步评估睡眠领域的临床成果是否与更大的疼痛耐受性、改善的情绪和提高的生活质量有关。20名继发性疼痛失眠的受试者将完成一项双向交叉设计的研究，随后进行多导睡眠描记术筛查。参与者将随机接受CBT- i或CBT治疗疼痛（CBT- p）作为两种治疗中的第一种。每次治疗将由训练有素的临床医生进行，每8周进行一次单独的治疗。在2周的基线期监测睡眠、疼痛情绪和生活质量症状，在每个治疗阶段每周监测一次，在治疗后3个月间隔监测2周。从F32中获得的数据将用于创建1)CBT-I与CBT-P的有效性和2)改善睡眠连续性对疼痛、情绪和生活质量的影响的效应大小估计。第二个目的是分析和比较受试者的睡眠结构和定量睡眠脑电图与其他失眠症患者和睡眠良好者的档案数据。预计CBT-I将对主要和次要结局指标产生中等到较大的影响。如果项目成功，这些数据将用作R21和/或K23应用程序的基础。最后，预计这类研究将为使CBT-I成为慢性疼痛管理的实践标准提供所需的证据。

DESCRIPTION (provided by applicant): Chronic pain affects 40-70 million people with nearly 90% experiencing disturbed sleep. While it is plausible that insomnia occurring in association with chronic pain has the same etiologic factors that contribute to Primary Insomnia little work has been undertaken to determine whether cognitive-behavioral therapy for insomnia (CBT-I) can be successfully applied to insomnia secondary to chronic pain. We propose to address this issue and to further assess whether clinical gains within the sleep domain are related to greater pain tolerance, improved mood and enhanced quality of life. Twenty subjects with insomnia secondary to pain will complete a two-way, cross-over designed study following a polysomnography screen. Participants will be randomized to receive either CBT-I or CBT for pain (CBT-P) as the first of two treatments. Each treatment will occur with trained clinicians in 8 weekly, individual sessions. Sleep, pain mood and quality of life symptoms will be monitored for a 2 week baseline period, weekly during each treatment phase and for a 2 week interval at 3 months post treatment. The data obtained from this F32 will be used to create effect size estimates for 1) the efficacy of CBT-I vs CBT-P and 2) the effects of improved sleep continuity on pain, mood, and quality of life. A secondary aim is to profile and compare subjects' sleep architecture and quantitative sleep EEGs to archival data from patients with other insomnias and with Good Sleepers. It is anticipated, that CBT-I will product moderate to large effects for both the primary and secondary outcome measures. If the project is successful, these data will be used as the basis for an R21 and/or a K23 application. Finally, it is anticipated that studies of this kind will provide the evidence required to make CBT-I a standard of practice for the management of chronic pain.