Cognitive‐Behavioral Treatment for Comorbid Insomnia and Osteoarthritis Pain in Primary Care: The Lifestyles Randomized Controlled Trial. Issue 6 (27th May 2013)

• Record Type: Journal Article
• Authors: Vitiello, Michael V.; McCurry, Susan M.; Shortreed, Susan M.; Balderson, Benjamin H.; Baker, Laura D.; Keefe, Francis J.; Rybarczyk, Bruce D.; Von Korff, Michael
• Is Part Of: Journal of the American Geriatrics Society. Volume 61:Issue 6(2013:Jun.)
• Page Start: 947
• Page End: 956
• Publication Date: 2013-05-27
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12275
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs12275-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12275-sec-0001" sec-type="section"> <title>Objectives</title> <p>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.</p> </sec> <sec id="jgs12275-sec-0002" sec-type="section"> <title>Design</title> <p>Double‐blind, cluster‐randomized controlled trial with 9‐month follow‐up.</p> </sec> <sec id="jgs12275-sec-0003" sec-type="section"> <title>Setting</title> <p>Group Health and University of Washington, 2009 to 2011.</p> </sec> <sec id="jgs12275-sec-0004" sec-type="section"> <title>Participants</title> <p>Three hundred sixty‐seven older adults with OA pain and insomnia.</p> </sec> <sec id="jgs12275-sec-0005" sec-type="section"> <title>Interventions</title> <p>Six weekly group sessions of CBT‐PI, CBT‐P, or EOC delivered in participants' primary care clinics.</p> </sec> <sec id="jgs12275-sec-0006" sec-type="section"> <title>Measurements</title> <p>Primary outcomes were insomnia severity and pain severity. Secondary outcomes were actigraphically measured sleep efficiency and arthritis symptoms.</p> </sec> <sec id="jgs12275-sec-0007" sec-type="section"> <title>Results</title> <p>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; <italic>P</italic> < .001) and CBT‐P (adjusted mean difference = −2.03, 95% CI = −3.01 to −1.04; <italic>P</italic> < .001) and improved sleep efficiency (score range 0–100) more than EOC (adjusted mean difference = 2.64, 95% CI = 0.44–4.84; <italic>P</italic> = .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; <italic>P</italic> = .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.</p> </sec> <sec id="jgs12275-sec-0008" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>