Treatment of Insomnia Secondary to Chronic Pain

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有相同的病因学因素是合理的，但很少有工作来确定失眠的认知行为疗法（CBT-I）是否可以成功地应用于继发于慢性疼痛的失眠。我们建议解决这个问题，并进一步评估睡眠领域的临床收益是否与更大的疼痛耐受性，改善情绪和提高生活质量有关。20例继发于疼痛的失眠受试者将在多导睡眠图筛查后完成一项双向、交叉设计的研究。参与者将随机接受CBT-I或CBT疼痛（CBT-P）作为两种治疗中的第一种。每种治疗将由经过培训的临床医生进行，每周进行8次单独治疗。睡眠、疼痛情绪和生活质量症状将监测2周基线期，每个治疗阶段每周一次，治疗后3个月间隔2周。从该F32中获得的数据将用于创建1）CBT-I与CBT-P的疗效和2）改善睡眠连续性对疼痛、情绪和生活质量的影响的效应量估计值。第二个目的是将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进行分析和比较。预计CBT-I将对主要和次要结局指标产生中度至重度影响。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，预计这类研究将提供必要的证据，使CBT-I成为慢性疼痛管理的实践标准。

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.