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The effectiveness of interventions in reducing sleep problems in chronic pain : a systematic review on randomized controlled trials

Akgül, M. (2019) The effectiveness of interventions in reducing sleep problems in chronic pain : a systematic review on randomized controlled trials.

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Abstract:Background. Sleep problems and chronic pain are major health issues worldwide and often co-occur. Sleep problems in chronic pain populations can decrease the quality of life of patients and worsen the severity of the condition. Recent research suggests that sleep problems are a strong predictor of pain, implicating that adequate treatment of sleep problems in chronic pain populations may be beneficial. The current systematic review aimed to assess the effectiveness of interventions in reducing sleep problems in chronic pain populations. Method. A systematic research was conducted in the electronic databases PubMed, PsycINFO and Web of Science, from May 2019 to June 2019. For each database, sleep-, pain- and RCT- related keywords were used. Inclusion criteria were: randomized controlled trials, English- language, interventions for sleep problems in chronic pain, participants with chronic pain for at least three months and published in the last 10 years (2009 – 2019). Children (≤17) were excluded. Results. Of the 688 articles identified, twenty met the inclusion criteria and were examined in detail. Twelve studies concerned behavioral therapeutic interventions, seven studies concerned pharmacological interventions and one study concerned an alternative medicine intervention. Of the behavioral therapeutic interventions, cognitive behavioral therapy for insomnia resulted in significant improvements in sleep problems, as well as in self-efficacy, catastrophic thoughts regarding pain, daily functioning and emotional distress (symptoms of depression). These findings were obtained after treatment and persisted up to 6- and 12-months. Of the pharmacological interventions, pregabalin, eszopiclone and very low doses of cyclobenzaprine were effective in reducing sleep problems, and these changes were accompanied by significant reductions in pain severity. However, these results were found after treatment and a follow-up was not conducted. In the alternative medicine intervention, no significant results were found. Conclusions. Cognitive behavioral therapy for insomnia seems effective in reducing sleep problems in chronic pain, and also improves self-efficacy, catastrophic thoughts regarding pain, daily functioning and emotional distress, which is important for the health-related quality of life of patients. Cognitive behavioral therapy is, therefore, a promising treatment option for sleep problems in chronic pain. Medications are not recommended, given the lack of long-term effectiveness, serious adverse effects, and the risk of habituation and tolerance. In addition, medications do not address psychological factors, which is important because reducing pain levels in chronic pain conditions is difficult. Keywords: sleep problems, chronic pain, randomized controlled trials
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
Link to this item:http://purl.utwente.nl/essays/80199
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