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Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study

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Abstract

Introduction

Chronic pain is difficult to treat and often precedes or exacerbates sleep disturbances such as insomnia. Insomnia, in turn, can amplify the pain experience. Both conditions are associated with inflammatory processes, which may be involved in the bi-directional relationship between pain and sleep. Cognitive behavioral therapy (CBT) for pain and CBT for insomnia are evidence based interventions for, respectively, chronic pain and insomnia. The study objectives were to determine the feasibility of combining CBT for pain and for insomnia and to assess the effects of the combined intervention and the stand alone interventions on pain, sleep, and mood outcomes compared to a control condition.

Methods

Twenty-one adults with co-occurring chronic pain and chronic insomnia were randomized to either CBT for pain, CBT for insomnia, combined CBT for pain and insomnia, or a wait-list control condition.

Results

The combined CBT intervention was feasible to deliver and produced significant improvements in sleep, disability from pain, depression and fatigue compared to the control condition. Overall, the combined intervention appeared to have a strong advantage over CBT for pain on most outcomes, modest advantage over both CBT for insomnia in reducing insomnia severity in chronic pain patients.

Discussion

CBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia.

Highlights

► It was feasible to combine and deliver CBT for pain and for insomnia to individuals with co-occurring pain and insomnia. ► The combined intervention was associated with large effects on sleep and depression, but minimal effects on pain. ► Compared to a control condition, CBT for insomnia (alone or in combination) significantly impacted sleep, but not pain.

Section snippets

Study sample

This randomized, open-label, parallel-arm, pilot study was conducted with institutional review board approval at the University of Rochester Medical Center. Men and women aged 35–75 experiencing chronic pain and insomnia were recruited from the community through newspaper advertisements and from local pain clinics via recruitment flyers. A total of 28 individuals were enrolled following a written informed consent process prior to participation. Following informed consent, participants completed

Results

Compared to the WL control condition, the CBT-P intervention was not associated with any significant improvements, although the largest effects on pain outcomes were observed in this condition (see Table 1). In contrast, compared to the WL condition, both the CBT-I and the CBT-I/P interventions were associated with significant improvements in primary outcomes of insomnia severity and depression severity. After adjusting for multiple comparisons no secondary outcomes met significance tests in

Discussion

Among patients with co-morbid pain and insomnia, CBT interventions explicitly addressing insomnia were superior to CBT-P alone in affecting sleep, depression and fatigue. Although the combined intervention was feasible to deliver, it was not associated with greater improvements in pain as assessed by the MPI or the PDI. The latter finding is not altogether surprising given that effect sizes for even pain-specific CBT treatments tend to be small (Eccleston et al., 2009). Nonetheless, given that

Acknowledgments

This study was supported by funding from the National Institutes of Health (F32NS049789 and K23NR01048), which had no role in any aspect of the study or this manuscript and the Rochester Center for Mind-Body Research (1R21AG023956, 1R24AG031089), faculty from which did contribute to writing this manuscript. The authors' views or opinions do not necessarily represent those of the Department of Veterans Affairs, the National Institutes of Health, or the United States Government. The authors wish

References (43)

  • K.D. Allen et al.

    Osteoarthritis and sleep: the Johnston County Osteoarthritis Project

    Journal of Rheumatology

    (2008)
  • Y. Benjamini et al.

    Controlling the false discovery rate – A practical and powerful approach to multiple testing

    Journal of the Royal Statistical Society Series B-Methodological

    (1995)
  • D. Casarett et al.

    Designing pain research from the patient's perspective: what trial end points are important to patients with chronic pain?

    Pain Medicine

    (2001)
  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1988)
  • S.R. Currie et al.

    Cognitive-behavioral treatment of insomnia secondary to chronic pain

    Journal of Consulting and Clinical Psychology

    (2000)
  • A.M. Drewes

    Pain and sleep disturbances with special reference to fibromyalgia and rheumatoid arthritis

    Rheumatology

    (1999)
  • W.W. Eaton et al.

    Center for Epidemiologic Studies Depression Scale: review and revision (CESD and CESD-R)

  • C. Eccleston et al.

    Psychological therapies for the management of chronic pain (excluding headache) in adults

    Cochrane Database of Systematic Reviews

    (2009)
  • J.D. Edinger et al.

    Behavioral insomnia therapy for fibromyalgia patients – A randomized clinical trial

    Archives of Internal Medicine

    (2005)
  • D.E. Ford et al.

    Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?

    Journal of the American Medical Association

    (1989)
  • L.C. Hedges

    Distribution theory for Glass's estimator of effect size and related estimators

    Journal of Educational Statistics

    (1981)

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