The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain.
OBJECTIVE
To assess the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in patients with non-malignant chronic pain.


METHODS
Twenty-eight subjects with chronic neck and back pain were stratified according to gender, age, and ethnicity, then assigned to one of the two treatment groups: CBT-I or a contact control condition.


METHODS
Eight weeks of CBT-I including sleep restriction, stimulus control, sleep hygiene, and one session of cognitive therapy devoted to catastrophic thoughts about the consequences of insomnia.


RESULTS
Outcomes included sleep diary assessments of sleep continuity, pre-post measures of insomnia severity (ISI), pain (Multidimensional Pain Inventory), and mood (BDI and POMS). Subjects receiving CBT-I (n=19), as compared to control subjects (n=9), exhibited significant decreases in sleep latency, wake after sleep onset, number of awakenings, and significant increase in sleep efficiency. The diary findings were paralleled by significant changes in the ISI (p=0.05). Significant improvement (p=0.03) was found on the Interference Scale of the Multidimensional Pain Inventory. The groups did not significantly differ on mood measures or measures of pain severity.


CONCLUSIONS
CBT-I was successfully applied to patients experiencing chronic pain. Significant improvements were found in sleep as well as in the extent to which pain interfered with daily functioning. The observed effect sizes for the sleep outcomes appear comparable to or better than meta-analytic norms for subjects with Primary Insomnia.
Jungquist
Carla R
CR
University of Rochester, School of Nursing, NY, USA. Carla_Jungquist@URMC.Rochester.edu
O'Brien
Chris
C
Matteson-Rusby
Sara
S
Smith
Michael T
MT
Pigeon
Wilfred R
WR
Xia
Yinglin
Y
Lu
Naiji
N
Perlis
Michael L
ML
D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010146:Pain / Q000150:complications* / Q000523:psychology; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D016037:Single-Blind Method; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome