title: Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial.
abstract: OBJECTIVE
  To assess whether older persons with osteoarthritis (OA) pain and insomnia receiving cognitive-behavioral therapy for pain and insomnia (CBT-PI), a cognitive-behavioral pain coping skills intervention (CBT-P), and an education-only control (EOC) differed in sleep and pain outcomes.
  
  
  METHODS
  Double-blind, cluster-randomized controlled trial with 9-month follow-up.
  
  
  METHODS
  Group Health and University of Washington, 2009 to 2011.
  
  
  METHODS
  Three hundred sixty-seven older adults with OA pain and insomnia.
  
  
  METHODS
  Six weekly group sessions of CBT-PI, CBT-P, or EOC delivered in participants' primary care clinics.
  
  
  METHODS
  Primary outcomes were insomnia severity and pain severity. Secondary outcomes were actigraphically measured sleep efficiency and arthritis symptoms.
  
  
  RESULTS
  CBT-PI reduced insomnia severity (score range 0-28) more than EOC (adjusted mean difference = -1.89, 95% confidence interval = -2.83 to -0.96; P < .001) and CBT-P (adjusted mean difference = -2.03, 95% CI = -3.01 to -1.04; P < .001) and improved sleep efficiency (score range 0-100) more than EOC (adjusted mean difference = 2.64, 95% CI = 0.44-4.84; P = .02). CBT-P did not improve insomnia severity more than EOC, but improved sleep efficiency (adjusted mean difference = 2.91, 95% CI = 0.85-4.97; P = .006). Pain severity and arthritis symptoms did not differ between the three arms. A planned analysis in participants with severe baseline pain revealed similar results.
  
  
  CONCLUSIONS
  Over 9 months, CBT of insomnia was effective for older adults with OA pain and insomnia. The addition of CBT for insomnia to CBT for pain alone improved outcomes.
authors.affiliation: Department ofPsychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Vitiello
authors.affiliation: Department ofPsychosocial and Community Health, School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Susan M
authors.initials: SM
authors.lastname: McCurry
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shortreed
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Balderson
authors.affiliation: Department ofPsychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Baker
authors.affiliation: Department of Psychology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.affiliation: Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Rybarczyk
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016000:Cluster Analysis; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000628:therapy*; D010147:Pain Measurement; D012189:Retrospective Studies; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome