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Cognitive‐Behavioral Treatment for Comorbid Insomnia and Osteoarthritis Pain in Primary Care: The Lifestyles Randomized Controlled Trial
Author(s) -
Vitiello Michael V.,
McCurry Susan M.,
Shortreed Susan M.,
Balderson Benjamin H.,
Baker Laura D.,
Keefe Francis J.,
Rybarczyk Bruce D.,
Korff Michael
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12275
Subject(s) - medicine , insomnia , physical therapy , randomized controlled trial , osteoarthritis , cognitive behavioral therapy , cognitive behavioral therapy for insomnia , confidence interval , psychiatry , alternative medicine , pathology
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 G roup H ealth and U niversity of W ashington, 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.