SEATTLE, WA—At SLEEP 2015, Jack Edinger, PhD, of the National Jewish Health, Denver, CO, presented research demonstrating that cognitive behavioral therapy (CBT) may indirectly improve fibromyalgia symptoms via improved sleep.
The presence of insomnia has been shown to worsen the fibromyalgia symptoms, including myalgias, tenderness, and fatigue. A team from the School of Nursing at the University of Murcia, Murcia, Spain, examined whether treating and improving sleep with CBT would lead to a positive and enduring effect on other fibromyalgia symptoms.
A total of 61 patients (mean age 51.6 [9.2], 51 female) were randomized to: treatment as usual (TAU; n=21), TAU plus sham therapy (n=20) or TAU plus CBT (n=20). The mean total wake time (TWT) hours derived from sleep diaries for two weeks at post-treatment was considered the primary sleep outcome. Severity and impact of fibromyalgia symptoms were assessed by scores on the Fibromyalgia Impact Questionnaire (FIQ) and the Brief Pain Inventory (BPI).
Mediation models using a non-parametric bootstrapping procedure to understand whether there was an indirect effect of CBT via sleep improvement were utilized on these three fibromyalgia-related outcomes at post-study and six-month follow-up evaluations. Bootstrapping analysis is a formal test of statistical significance of the indirect effect of a treatment on a specific outcome.
Patients receiving CBT had statistically significant shorter TWT at POST (P=0.004) vs. those who were taking TAU and TAU plus sham therapy. The mediation model revealed a beneficial and statistically significant indirect effect of CBT on the on the three fibromyalgia-related outcomes occurring at POST via a reduction of nocturnal TWT 9-4.48 FIQ score point estimate (95% CI -7.98/-1.56); pain intensity -0.39 (95%CI -0.79/-0.0); and pain interference -0.50 (95% CI -0.91/-0.17). The effects of CBT on the three fibromyalgia-related outcomes at follow-up, happening through a reduction of TWT at POST, was also statistically significant
“Insomnia might not just be a consequence of pain but might be pathogenic,” so improving sleep can indirectly improve pain and other fibromyalgia symptoms, said Dr. Edinger, one of the researchers. He noted that the indirect beneficial impact of CBT on fibromyalgia symptoms reflects a statistically meaningful improvement. “We don’t yet know the clinically significant improvements, which remain to be ascertained.” Nevertheless, he suggested “incorporating sleep treatment strategies, such as CBT and sleep hygiene, into standard care practice for patients with fibromyalgia.”