Tang, N.K., Lereya, S.T., Boulton, H., Miller, M.A., Wolke, D., & Cappuccio, F.P. (2015). Nonpharmacological treatments of insomnia for long-term painful conditions: A systematic review and meta-analysis of patient-reported outcomes in randomized controlled trials. Sleep, 38, 1751–1764.

DOI Link

Purpose

STUDY PURPOSE: To evaluate the effects of nonpharmacologic interventions on patient-reported sleep, pain, and well-being in people with cancer and other conditions

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Cochrane Collaboration, MEDLINE, EMBASE, and PsycINFO
 
INCLUSION CRITERIA: Randomized, controlled trials; intervention aimed to improve sleep in patients with painful conditions

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,887
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Evaluation following Cochrane guidelines and additional criteria; blinding was excluded because interventions of interest could not be fully blinded; only two studies showed high risk of bias

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 11
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,066
  • SAMPLE RANGE ACROSS STUDIES: 28–276
  • KEY SAMPLE CHARACTERISTICS: Included cancer, arthritis, fibromyalgia, musculoskeletal pain, and headache as painful conditions; six studies were of patients with cancer

Phase of Care and Clinical Applications

PHASE OF CARE: Not specified or not applicable

Results

All treatments had at least one component of cognitive behavioral therapy for insomnia. Subgroup analysis showed that the interventions tested were significant for both cancer and noncancer cases. Another subgroup analysis showed that effectiveness was significant for face-to-face interventions but not for those conducted via the phone or Internet. Analysis showed effects for sleep (standard mean difference [SMD] = 0.78, p < 0.0001 with high heterogeneity), pain (SMD = 0.18, p = 0.05), and fatigue (SMD = 0.38, p = 0.01).

Conclusions

Nonpharmacologic interventions involving components of cognitive behavioral therapy for insomnia were shown to be effective in improving sleep, pain, and fatigue among patients with and without cancer.

Limitations

High heterogeneity

Nursing Implications

Interventions like cognitive behavioral for insomnia are beneficial to improve sleep, reduce fatigue, and positively affect pain.

Legacy ID

6298