Researchers in the U.S. have recently conducted a study to examine the effects of cognitive behavioural therapy (CBT) on the brains of patients with fibromyalgia and insomnia.
There is a high prevalence of individuals who suffer from insomnia and chronic pain, with both occurring simultaneously in 50% to 80% of cases. This presents great challenges for both individuals and society due to the resulting health care costs and a decrease in quality of life. Sleep and pain can affect one another, as pain can decrease the amount of quality sleep obtained, and poor sleep can increase the level of pain.
Despite the apparent exchange between these two conditions, the degree to which they share causal factors is not well understood. Recently, much effort has been made to try and understand the causes of chronic pain and much of this investigation has concentrated on the central nervous system. Likewise, researchers have established hyperarousal as a factor which can develop and maintain insomnia.
Pain and sleep disturbance can often occur together, possibly because they both share a common neurophysiological pathway. Those with fibromyalgia are a suitable population to study both pain and insomnia, as most individuals with fibromyalgia suffer from sleep problems.
It has been shown from previous research that fibromyalgia and insomnia are associated with the shrinking, known as atrophy, of the grey matter within the brain. The preliminary results of this recent study demonstrate that CBT may be able to slow down this shrinking of the grey matter of the brain.
In a recent pilot study, researchers employed two types of CBT: CBT for Pain (CBT-P) and CBT for Insomnia (CBT-I). Overall, the results of the study showed those who received no CBT showed a thinning of the grey matter in the brain, while individuals who received CBT-P showed less shrinking of the brain during the same time period. Most interestingly, those who received CBT-I showed an increase in the thickness of the grey matter within the brain.
This pilot study, published in the Journal of Clinical Sleep Medicine, provides new and promising evidence that a CBT course as short as eight weeks may be sufficient to change the structure of the central nervous system of patients with fibromyalgia and insomnia. In addition to this, these preliminary results demonstrate that CBT-I is superior as it increases the thickness of the grey matter of the brain; CBT-P only attenuates the shrinking of the grey matter.
This pilot study serves to provide data which can provide a starting point for future research work that may lead to greater changes in structure and important changes in the experiences of sleep and pain. Future research work is required with larger numbers of patients and longer follow-ups, in order to establish the viability and limitations of this population and the robustness of these changes.
Written by Jade Marie Evans, MPharm, Medical Writer
Reference: McCrae, C.S. 2018. Gray Matter Changes Following Cognitive Behavioral Therapy for Patients With Comorbid Fibromyalgia and Insomnia: A Pilot Study. [Online]. [22 October 2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134244/
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