The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain
Received 16 March 2009; received in revised form 11 May 2009; accepted 30 May 2009.
Abstract
Study objectives
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.
Intervention
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.
Measurements and 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.
aUniversity of Rochester, School of Nursing, NY, USA
bUniversity of Rochester, Department of Anesthesiology, NY, USA
cUniversity of Rochester, Sleep and Neurophysiology Research Laboratory, NY, USA
dJohn Hopkins University, Department of Psychiatry and Behavioral Sciences, MD, USA
eUniversity of Rochester, Department of Biostatistics, NY, USA
fUniversity of Pennsylvania, Department of Psychiatry, PA, USA
Corresponding authors. Addresses: University of Rochester, Department of Anesthesiology, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA. Tel.: +1 585 275 3524; fax: +1 585 473 5007 (C.R. Jungquist), University of Pennsylvania, Department of Psychiatry, Blockley Hall, Philadelphia, PA 19104-6021, USA. Tel.: +1 215 746 3577; fax: +1 270 512 9828 (M.L. Perlis).
ABSTRACT