Cognitive behavioral therapy (CBT) has been used for the treatment of mood disorders and chronic conditions for a long time. Individuals suffering from chronic pain syndromes have been shown to benefit from the addition of CBT in their treatment, but CBT has not been shown to provide sustained pain relief in patients with fibromyalgia (FM). In the treatment of FM, CBT has been effective in improving other symptoms such as physical function, self-efficacy, and dysfunctional thought. For these reasons, CBT has been suggested for FM patients who suffer from emotional symptoms in addition to pain.
A recent study “Sleep and Pain Interventions in Fibromyalgia (SPIN)” sought to examine the effects of CBT for insomnia (CBTi) on the resting brain activity of individuals with comorbid fibromyalgia and chronic insomnia (FMI). Eleven participants completed daily sleep and pain diaries for 14 days before and after undergoing 8 weeks of CBTi. Brain scanning was completed before the initial diaries were started and after the final diaries were completed, and consisted of alternating intervals of heat testing. The time periods between heat testing were used to represent resting brain activity.
This study found that increased total sleep time (TST) following CBTi correlated with resting brain activity, decreased total wake time (TWT) led to decreased resting brain activity, and decreased clinical pain (CP) also resulted in decreased resting activity. The most significant decrease in brain activity following CBTi was found in the regions responsible for language, spatial awareness, and somatosensory processing. These findings suggest that CBTi decreased sleep difficulties as well as exaggerated somatic focus on painful events and sleep difficulties.
This study seems to indirectly address an important problem of FM patients, namely the prolonged and more intense unpleasant sensations they experience. After CBTi FM patient slept better and were able to recover from painful experiences faster than before the sleep intervention
The strong relationship between sleep and pain has been known for a long time. In improving sleep, pain will also improve. If CBTi helps patients improve their sleeping patterns, this may mean that CBTi either directly or inderectly helps to decrease CP. As a result, it might be beneficial for FM patients to consider CBT if they suffer from trouble sleeping.
Meriem Mokhtech, BS
Senior Laboratory Technician
UF Center for Musculoskeletal Pain Research