• Anneleen Malfliet, Thomas Bilterys, Eveline Van Looveren, Mira Meeus, Lieven Danneels, Kelly Ickmans, Barbara Cagnie, Olivier Mairesse, Daniel Neu, Maarten Moens, Dorien Goubert, Steven J Kamper, and Jo Nijs.
• Research Foundation - Flanders (FWO), Brussels, Belgium; Pain in Motion International Research Group(1); Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium. Electronic address: Anneleen.Malfliet@vub.be.
• Rev Bras Fisioter. 2019 Jan 1; 23 (1): 62-70.

BackgroundInsomnia is a highly prevalent and debilitating comorbidity that is often not addressed in therapy for chronic spinal pain (CSP). Given the close interaction between insomnia and CSP severity and related disability, targeting sleep problems during therapy could improve treatment outcomes in these patients.ObjectiveCan cognitive behavioral therapy for insomnia (CBT-I) combined with the modern neuroscience approach (i.e. pain neuroscience education and cognition-targeted exercise therapy) reduce pain and improve sleep, physical activity and function in people with CSP and comorbid insomnia?MethodsParticipants: One-hundred-twenty participants with chronic spinal pain and comorbid insomnia Intervention: CBT-I combined with the modern neuroscience approach (experimental) compared to the modern neuroscience approach alone (control). Both interventions start with three sessions of pain neuroscience education, followed by six sessions of CBT-I and nine sessions of cognition-targeted exercise therapy in the experimental group, or 15 sessions of cognition-targeted exercise therapy in the control group.MeasurementsPrimary outcome measure: self-reported pain severity (Brief Pain Inventory).Secondary Outcome Measurespain sensitivity (pressure pain thresholds, and online questionnaires), sleep-related outcomes (home-based polysomnography and online questionnaires), physical activity (actigraphy), and function (online questionnaires). Online questionnaires will be completed at baseline, directly post-treatment, and at 3, 6 and 12 months post-treatment. Polysomnography, pressure pain thresholds and actigraphy will be carried out at baseline, post-treatment and at 12 months follow-up.DiscussionFindings may provide (1) a novel therapeutic approach for people with CSP and comorbid insomnia to improve pain, sleep, physical activity and function, and (2) new treatment guidelines for professionals.Trial RegistrationClinicaltrials.gov NCT03482856 (https://clinicaltrials.gov/ct2/show/NCT03482856).Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

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