Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial.

OBJECTIVES: 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. DESIGN: Double-blind, cluster-randomized controlled trial with 9-month follow-up. SETTING: Group Health and University of Washington, 2009 to 2011. PARTICIPANTS: Three hundred sixty-seven older adults with OA pain and insomnia. INTERVENTIONS: Six weekly group sessions of CBT-PI, CBT-P, or EOC delivered in participants' primary care clinics. MEASUREMENTS: 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. CONCLUSION: 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.

Duke Scholars

Author Francis Joseph Keefe Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...