Does small-group sleep therapy improve sleep, pain and quality of life for people with chronic pain?

The CBTi intervention titled 'sleeping well with persistent pain' will comprise 6 x 1hr small-group sessions (held once weekly), with approximately 7 participants per group. These sessions are held face-to-face in a group room at our Pain Unit clinic. Group content is guided by Tang’s CBTi for Chronic Pain protocol (2022: CBT-I Protocol for Insomnia Co-morbid with Chronic Pain. Cognitive-Behavioural Therapy For Insomnia (CBT-I) Across The Life Span: Guidelines and Clinical Protocols for Health Professionals). The intervention will include key elements of CBTi; sleep hygiene, stimulus control, sleep restriction, relaxation, and cognitive therapy. Participants receive a treatment manual with all study materials, as well as space to record individualised treatment plans, and weekly homework tasks and progress. Two facilitators are present at each intervention session, to help ensure participants are kept engaged. Facilitators are one provisional and one registered psychologist, trained in CBTi, and completing a combined Masters and PhD (Clinical Psychology). During all 6 weeks of the intervention, group participants will be required to use wrist-based actigraphy devices to monitor their sleep parameters (including total sleep time, sleep onset latency, wake after sleep onset), and this information will be used to adapt the treatment type/degree offered during the subsequent group session. Participants will also supplement this information by completing detailed sleep diaries for the entire 6 weeks of the intervention. During each of the 6 CBTi sessions, participants will also complete an 8-item measure of excessive daytime sleepiness, the Epworth Sleepiness Scale (ESS). The information gained from these scales will help the group facilitators to individualise and then progressively adapt the treatment approach for each participant throughout the 6-week group. Additionally, participants will complete the 10-item Pain Related Beliefs and Attitudes about Sleep (PBAS) scale on paper in the first and last sessions, for therapeutic reasons - to more closely monitor participants' progress/response to treatment, and reflect any progress back to participants, and provide a more detailed discharge letter and suggested next steps to GPs. Session attendance is recorded by the facilitators, and non-attending participants are followed up via phone call to determine the reason for non-attendance. Patients indicate their initial interest to hear more about the study to their Pain Unit doctor. Then, at the point of attempted recruitment by the study coordinator, participants choose to be allocated to the intervention (CBTi) condition (this is the default option). Patients who decline to participate in the intervention group after contact by the study coordinator (perhaps due to other commitments, needing to travel long distances, not liking group therapy) are offered participation in the control condition (treatment as usual, and simply completing outcome measures at three timepoints).