Objectives / Introduction:
Chronic pain, in contrast to acute pain, has lost his
tissue-danger-signalling property and may cause suffering, loss of
function and decrease in quality of life (QoL). Patients with
chronic pain often suffer from poor sleep quality and comorbid
affective symptoms. Increasing data show a pain-enhancing effect of
sleep loss/poor sleep (Finan et al., 2013, Journal of Pain).
Interdisciplinary multimodal pain therapy (IMPT), based on the
biopsychosocial model, is a collaborative approach and the gold
standard to address the multifaceted dimensions of chronic pain. The
aim of this study was both to explore prevalence of sleep
disturbance in chronic pain patients and to evaluate sleep-related
benefit of an IMPT.
This retrospective single-arm interdisciplinary study included 151
patients (101 women, 50 men, mean age = 45.2) with chronic pain
(CHOP criteria). We assessed the prevalence sleep disturbance using
the Insomnia Severity Index (ISI) at T0 (start of 3.5-week IMPT). We
furthermore compared pre-post changes in ISI scores of 32 patients
(24 women, 8 men) between T0 and T1 (6 months after completion of
IMPT) by performing paired t-tests (87% statistical power).
The mean ISI score among all patients was 13.7 (SD = 6.2) on a 0 -
21 scale. This meets the criteria of a subthreshold insomnia whereas
a cut-off score of ≥ 15 indicates clinical relevance. 74 patients
resp. 49% of the sample showed clinical relevant ISI scores. The
results from the pre-IMPT (M = 12.3, SD = 5.5) and post-IMPT (M =
9.8, SD = 6.1) reflect a statistical significant decrease in
insomnia severity, t(31) = 2.4, p = .021, d = .431. We could not
identify any predictors (e.g. sex, age, employment status) with
regard to sleep-related benefit of the IMPT.
Although results demonstrate statistically significant pre-post
improvement in insomnia, 8 patients resp. 25% of the subsample
showed clinically relevant post-intervention ISI scores. As clinical
IMPT programs often lack initial sleep assessment and sleep-specific
modules, we suggest to implement such additional offers, e.g.
cognitive behavioral therapy for insomnia (CBT-I), into existing
therapies. This may contribute to prevent sleep disturbance in
patients with chronic pain.