Analgesic benefits of pharmacological and nonpharmacological sleep interventions for adults with fibromyalgia: a systematic review and meta-analyses

Fibromyalgia is a chronic musculoskeletal pain condition affecting 2% to 8% of the population. Most people with fibromyalgia experience poor sleep, and sleep problems consistently predict pain severity. Given the bidirectional relationship between sleep and pain, improving sleep may reduce fibromyalgia pain. This review identified trials of sleep-focused pharmacological and nonpharmacological interventions to evaluate whether they improved pain outcomes for adults with fibromyalgia. A systematic search of 7 electronic databases, 2 trial registries, and the reference lists of related studies retrieved 5728 records. Three independent reviewers completed study screening, data extraction, and risk of bias assessments. Nineteen studies met the inclusion criteria. Sleep interventions were evaluated against inactive and active control groups in a total of 10 trials with self-reported pain outcomes. Sodium oxybate significantly improved pain compared with placebo at postintervention (4.5 g: MD = -8.53, 95% CI [-12.08, -4.98]; 6.0 g: SMD = -0.46, 95% CI [-0.60, -0.31]). Cognitive behavioural therapy (CBT) for insomnia did not significantly improve pain compared with usual care at postintervention ( MD = -4.73, 95% CI [-10.89, 1.43]). Comparisons of CBT for insomnia with sleep hygiene training, and combined CBT for insomnia and pain with CBT for pain showed no significant postintervention differences. Other interventions (eg, melatonin and zopiclone) were identified but had insufficient data to allow meta-analysis. This review provided preliminary support for the analgesic benefits of some sleep interventions for adults with fibromyalgia. Long-term effects of sleep interventions on pain should be investigated to further inform treatment planning efforts.