The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain

Jungquist, Carla R.; O’Brien, Chris; Matteson-Rusby, Sara; Smith, Michael T.; Pigeon, Wilfred R.; Xia, Yinglin; Lu, Naiji; Perlis, Michael L.

doi:10.1016/j.sleep.2009.05.018

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Volume 11, Issue 3 , Pages 302-309, March 2010

The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain

Carla R. Jungquist
- University of Rochester, School of Nursing, NY, USA
- University of Rochester, Department of Anesthesiology, NY, USA
- University of Rochester, Sleep and Neurophysiology Research Laboratory, NY, 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).
Chris O’Brien
- University of Rochester, School of Nursing, NY, USA
- University of Rochester, Sleep and Neurophysiology Research Laboratory, NY, USA
Sara Matteson-Rusby
- University of Rochester, Sleep and Neurophysiology Research Laboratory, NY, USA
Michael T. Smith
- John Hopkins University, Department of Psychiatry and Behavioral Sciences, MD, USA
Wilfred R. Pigeon
- University of Rochester, Sleep and Neurophysiology Research Laboratory, NY, USA
Yinglin Xia
- University of Rochester, Department of Biostatistics, NY, USA
Naiji Lu
- University of Rochester, Department of Biostatistics, NY, USA
Michael L. Perlis
- University 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).

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.

Keywords: Insomnia, Pain, Cognitive-behavioral therapy, Sleep, Nurse therapist, Randomized controlled trial, Chronic pain