Outcomes of Cognitive-Behavioral Treatment for Insomnia on Insomnia, Depression, and Fatigue for Individuals with Multiple Sclerosis: A Case Series.

BACKGROUND: This clinical case series examined outcomes of cognitive-behavioral therapy for insomnia (CBT-I) in individuals with multiple sclerosis (MS). Current literature links insomnia with higher rates of depression and fatigue in individuals with MS. However, no research to date evaluates a targeted psychotherapeutic intervention for insomnia in this population. PARTICIPANTS AND METHODS: Eleven individuals with a diagnosis of MS and insomnia participated in individual or group-based CBT-I sessions at the Cleveland Clinic Sleep Disorders Center between 2008 and 2013. A medical record review examined these individuals' self-reported experiences of insomnia, depression, and fatigue at the preintervention and postintervention levels using the Insomnia Severity Index, nine-item Patient Health Questionnaire, and Fatigue Severity Scale. Total sleep time was also reported at pretreatment and posttreatment intervals. RESULTS: Overall, participants reported improvements regarding insomnia, fatigue, and depression after CBT-I. Total sleep time also increased by an average of 1.5 hours. Despite overall improvement, symptoms of fatigue, insomnia, and depression persisted, at varying levels, for most participants. CONCLUSIONS: These results strongly suggest that CBT-I may serve as an effective clinical intervention for individuals with MS who report symptoms of insomnia. Given the considerable overlap of experiences of insomnia, depression, and fatigue in people with MS, CBT-I may also be helpful in identifying areas that may require additional clinical intervention for persistent symptoms of depression and fatigue. Further research is necessary.

Who is Taking Care of the Caregiver?

In neurology practices, the patient's caregiver is often overlooked, but it is essential to understand the importance of the caregiver in the management of a chronic neurological condition. Caring for a loved one with a chronic condition can often be profoundly fulfilling, as many times individuals move closer together when challenges arise; however it can also become overwhelming, physically and emotionally challenging, and isolating. At times, it can be thought of as a burden. Caregivers must learn to take care of themselves physically and emotionally. The multidisciplinary care model used in the treatment of chronic medical conditions is important not only for the patient or care recipient, but also for the caregiver. This care model allows for several practitioners to interact with the caregiver to assess and determine the optional interventions. The purpose of this article is to review common caregiver challenges and to determine how, as providers, we can address and help caregivers more effectively care for themselves while maintaining their responsibility to the patient or care recipient.

A systematic review of stress-management interventions for multiple sclerosis patients.

BACKGROUND: The objective of this study was to identify stress-management interventions used for people with multiple sclerosis (MS) and systematically evaluate the efficacy of these interventions. METHODS: Several strategies were used to search for studies reported in articles published up to 2013. RESULTS: Our initial search retrieved 117 publications, of which 8 met our criteria for review. Of the eight studies, one provided Class I evidence, five provided Class III evidence, and two provided Class IV evidence for the efficacy of stress-management interventions according to the evidence classification established by the American Academy of Neurology. Most studies showed positive changes in outcomes assessed; however, the range of methodological quality among the published studies made it difficult to draw conclusions. CONCLUSIONS: The promising findings for stress-management interventions highlight the need for future studies. Additional large, prospective, multicenter studies will help to define the role of stress-management interventions in the treatment and course of MS. Furthermore, including outcome measures based on biological and clinical markers of disease will prove useful in understanding potential underlying mechanisms.

The role of exercise and types of exercise in the rehabilitation of chronic pain: specific or nonspecific benefits.

Chronic pain is one of the most common complaints seen in general practitioners' offices, and it contributes to social, emotional, physical, and economical losses. The management of this problem poses challenges for health care providers when the current treatment of choice for chronic pain is pharmacological management, which may not be a sufficient and/or holistic approach to the management of chronic pain. Our goal is to increase awareness of the significance of physical activity, as well as examine additional cost-effective, integrated approaches to help manage the complex and debilitating effects of this condition. This article summarizes the types of exercise in the rehabilitation of chronic pain patients and provides practical recommendations for the clinician based on empirical and clinical experience. This safe, cost-free, nonpharmacologic way of managing pain has been found to reduce anxiety and depression, improve physical capacity, increase functioning and independence, and reduce morbidity and mortality.

Interdisciplinary treatment of patients with multiple sclerosis and chronic pain: a descriptive study.

The objective of this study was to examine the efficacy of an interdisciplinary pain rehabilitation program in a multiple sclerosis (MS) population by evaluating changes in mood, pain, and functioning. This descriptive study examined 20 patients with chronic pain and MS who were admitted to the Cleveland Clinic's Chronic Pain Rehabilitation Program (CPRP) between 2000 and 2009. At both admission to and discharge from the CPRP, measures of pain, depression, and functioning were obtained using a pain visual analogue scale (VAS), the Beck Depression Inventory (BDI), the Depression Anxiety Stress Scale (DASS), and the Pain Disability Index (PDI). Outcomes for the MS patients were compared with those of patients without MS who had participated in the same program. The results showed that MS patients who completed the CPRP reported dramatic decreases in pain and depression and an increase in daily functioning. The benefits received by MS patients from the program were similar to those received by patients without MS. Thus programs like the CPRP can result in significant improvements in pain, depression, and functioning among people with MS.

Immediate benefits of a brief 10-minute exercise protocol in a chronic pain population: a pilot study.

OBJECTIVE: Determining the acute effects of a brief, 10-minute exercise protocol on pain, mood, and perceived exertion. PATIENTS: Twenty-eight subjects who were admitted to the Cleveland Clinic Chronic Pain Rehabilitation Program (CPRP), and who were capable of completing an experimenter-designed and controlled treadmill protocol were included in this pilot study. METHODS: A within-group repeated measure analysis was used to compare 28 subjects admitted to the Cleveland Clinic CPRP. Measures of heart rate were obtained using the Nellcor Oximax, pulse oximeter; measures of mood and pain were obtained using a 0-10 Likert scale, and perceived exertion measured with a visual analog scale. Each measure was taken pre- and post-10-minute exercise protocol. RESULTS: The brief exercise protocol was associated with self-report of immediate antidepressant and anxiolytic effects. Additionally, after the 3-week CPRP, self-reports in perceived exertion decreased. Brief exercise was not found to have an acute analgesic effect. CONCLUSION: This preliminary research revealed a temporal association of improvement in self-rated anxiety and depression, following a brief exercise protocol, and over the course of 3 weeks leads to decreased perceived exertion. Therefore suggesting that brief exercise is a safe, nonpharmacologic strategy for immediately improving mood, and has further implications for mortality risk.