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

Carla R Jungquist, Yolande Tra, Michael T Smith, Wilfred R Pigeon, Sara Matteson-Rusby, Yinglin Xia, Michael L Perlis, Carla R Jungquist, Yolande Tra, Michael T Smith, Wilfred R Pigeon, Sara Matteson-Rusby, Yinglin Xia, Michael L Perlis

Abstract

The purpose of this study was to assess the long-term (six months) effects of cognitive behavioral therapy for insomnia (CBT-I) in patients with chronic pain. The results of the pre-post treatment effects have been reported previously. The therapy was delivered by an advanced practice nurse in a research setting using a parallel-group, randomized, single blind trial of CBT-I with a contact/measurement control condition. Outcomes included sleep diary, the Insomnia Severity Index, the Multidimensional Pain Inventory, the Beck Depression Inventory, the Profile of Mood States-short form, and the Pain Disability Index. Measurement time points were end-of-treatment, three-month and six-month posttherapy. Subjects receiving CBT-I (n = 19), as compared to control subjects (n = 9), did not exhibit any significant group by visit effects on measures of sleep, pain, mood, or function after end of treatment. However, subjects in the treatment group exhibited statistically (P = 0.03) and clinically significant improvement in total sleep time (23 minutes) over the six months following treatment. In this paper, cognitive behavioral therapy directed to improve insomnia was successfully delivered to patients with moderate-to-severe chronic pain and the positive effects of CBT-I continued to improve despite the presence of continued moderate-to-severe pain.

Figures

Figure 1
Figure 1
Subject flow diagram.
Figure 2
Figure 2
Change score end of treatment to six-month followup.

References

    1. American Academy of Pain Medicine. AAPM Facts and Figures on Pain, 2012, .
    1. Ashworth PC, Davidson KM, Espie CA. Cognitive-behavioral factors associated with sleep quality in chronic pain patients. Behavioral Sleep Medicine. 2010;8(1):28–39.
    1. Ohayon MM. Pain sensitivity, depression, and sleep deprivation: links with serotoninergic dysfunction. Journal of Psychiatric Research. 2009;43(16):1243–1245.
    1. Pigeon W, Park R, Sateia M. Sleep and Pain. In: Lader M, Cardinali D, Pandi-Perumal SR, editors. Sleep and Sleep Disorders: A Neuropsychological Approach. Austin, Tex, USA: Landes Bioscience; 2004.
    1. Tang NK, Wright KJ, Salkovskis PM. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. Journal of Sleep Research. 2007;16(1):85–95.
    1. Vitiello MV, Rybarczyk B, Von Korff M, Stepanski EJ. Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis. Journal of Clinical Sleep Medicine. 2009;5(4):355–362.
    1. Currie SR, Clark S, Hodgins DC, El-Guebaly N. Randomized controlled trial of brief cognitive-behavioural interventions for insomnia in recovering alcoholics. Addiction. 2004;99(9):1121–1132.
    1. Currie SR, Wilson KG, Pontefract AJ, deLaplante L. Cognitive-behavioral treatment of insomnia secondary to chronic pain. Journal of Consulting and Clinical Psychology. 2000;68(3):407–416.
    1. Edinger JD, Wohlgemuth WK, Krystal AD, Rice JR. Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial. Archives of Internal Medicine. 2005;165(21):2527–2535.
    1. Jungquist CR, O'Brien C, Matteson-Rusby S, Smith MT, Pigeon WR, Xia Y, et al. The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain. Sleep Medicine. 2010;11(3):302–309.
    1. Bastien CH, Vallieres A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Medicine. 2001;2(4):297–307.
    1. Yang M, Morin CM, Schaefer K, Wallenstein GV. Interpreting score differences in the Insomnia Severity Index: using health-related outcomes to define the minimally important difference. Current Medical Research and Opinion. 2009;25(10):2487–2494.
    1. Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) Pain. 1985;23(4):345–356.
    1. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. The Journal of Pain. 2008;9(2):105–121.
    1. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1):9–19.
    1. Changulani M, Shaju A. Evaluation of responsiveness of Oswestry low back pain disability index. Archives of Orthopaedic and Trauma Surgery. 2009;129(5):691–694.
    1. Chibnall JT, Tait RC. The pain disability index: factor structure and normative data. Archives of Physical Medicine and Rehabilitation. 1994;75(10):1082–1086.
    1. McNair DM, Lorr M, Droppleman LF. Manual of the Profile of Mood States. San Diego, Calif, USA: Educational and Industrial Testing Service; 1992.
    1. Carney CE, Ulmer C, Edinger JD, Krystal AD, Knauss F. Assessing depression symptoms in those with insomnia: an examination of the beck depression inventory second edition (BDI-II) Journal of Psychiatric Research. 2009;43(5):576–582.
    1. Dozois DJA, Dobson KS, Ahnberg JL. A psychometric evaluation of the Beck Depression Inventory-II. Psychological Assessment. 1998;10(2):83–89.
    1. Smith MT, Perlis ML, Park A, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. American Journal of Psychiatry. 2002;159(1):5–11.
    1. Yang M, Morin CM, Schaefer K, Wallenstein GV. Interpreting score differences in the Insomnia Severity Index: using health-related outcomes to define the minimally important difference. Current Medical Research and Opinion. 2009;25(10):2487–2494.
    1. Kowalski J, Tu XM. Models for Clustered Data. Modern Applied U Statistics. New York, NY, USA: Wiley; 2007.
    1. Muthen B, Muthen L. Mplus User's Guide. Los Angeles, Calif, USA: 2001.
    1. Arnedt JT, Rohsenow DJ, Almeida AB, et al. Sleep following alcohol intoxication in healthy, young adults: effects of sex and family history of alcoholism. Alcoholism: Clinical and Experimental Research. 2011;35(5):870–878.
    1. Buysse DJ, Germain A, Moul DE, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Archives of Internal Medicine. 2011;171(10):887–895.
    1. Garland SN, Carlson LE, Antle MC, Samuels C, Campbell T. I-CAN SLEEP: rationale and design of a non-inferiority RCT of mindfulness-based stress reduction and cognitive behavioral therapy for the treatment of Insomnia in CANcer survivors. Contemporary Clinical Trials. 2011;32(5):747–754.
    1. Howland RH. Sleep interventions for the treatment of depression. Journal of Psychosocial Nursing and Mental Health Services. 2011;49(1):17–20.027936
    1. Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep. 2008;31(4):489–495.
    1. Miro E, Lupianez J, Martinez MP, Sanchez AI, Diaz-Piedra C, Guzman MA, et al. Cognitive-behavioral therapy for insomnia improves attentional function in fibromyalgia syndrome: a pilot, randomized controlled trial. Journal of Health Psychology. 2011;16(5):770–782.135910
    1. Tremblay V, Savard J, Ivers H. Predictors of the effect of cognitive behavioral therapy for chronic insomnia comorbid with breast cancer. Journal of Consulting and Clinical Psychology. 2009;77(4):742–750.
    1. Ulmer CS, Edinger JD, Calhoun PS. A multi-component cognitive-behavioral intervention for sleep disturbance in Veterans with PTSD: a pilot study. Journal of Clinical Sleep Medicine. 2011;7(1):57–68.
    1. Van Houdenhove L, Buyse B, Gabriels L, Van Diest I, Van Den Bergh O. Cognitive-behavioural therapy for primary insomnia: effectiveness in a clinical setting. Tijdschrift voor Psychiatrie. 2010;52(2):79–88.
    1. Currie SR, Wilson KG, Pontefract AJ, deLaplante L. Cognitive-behavioral treatmentof insomnia secondary to chronic pain. Journal of Consulting and Clinical Psychology. 2000;68(3):407–416.
    1. Bacchetti P, Deeks SG, McCune JM. Breaking free of sample size dogma to perform innovative translational research. Science Translational Medicine. 2011;3(87)87ps24
    1. Broderick JE, Junghaenel DU, Schwartz JE. Written emotional expression produces health benefits in fibromyalgia patients. Psychosomatic Medicine. 2005;67(2):326–334.
    1. Cole CS, Richards KC, Smith-Olinde L, Roberson PK, Sullivan DH. Tone-induced sleep fragmentation in persons with Alzheimer’s disease: a feasibility study. Biological Research for Nursing. 2010;11(3):229–235.
    1. Smith JA, Lumley MA, Longo DJ. Contrasting emotional approach coping with passive coping for chronic myofascial pain. Annals of Behavioral Medicine. 2002;24(4):326–335.
    1. Edinger JD, Wohlgemuth WK, Radtke RA, Coffman CJ, Carney CE. Dose-response effects of cognitive-behavioral insomnia therapy: a randomized clinical trial. Sleep. 2007;30(2):203–212.
    1. Espie CA. ‘Stepped care’: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep. 2009;32(12):1549–1558.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する