0392 "I'm Adventuring More": Exploring the Meaning of Cognitive Behavioral Therapy for Insomnia (CBT-I) for Patients with Pain. (12th April 2019) - Koffel, Erin
Abstract: Introduction: Insomnia is one of the most common, persistent, and distressing symptoms associated with chronic pain. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia, but patient preferences and perspectives about CBT-I within the context of chronic pain are unknown. The current qualitative study sought to understand the experience of CBT-I among patients with chronic pain, including the connection of pain and insomnia, aspects of CBT-I that were appreciated or found to be difficult, and changes in sleep and pain functioning. Methods: We conducted individual semi-structured interviews with 17 Veterans with chronic pain and insomnia who had recently participated in CBT-I and used thematic analysis to identify conceptual themes. After all coding was complete, the analysis team met to organize coded data into categories and to identify higher order themes. Results: We identified several core themes regarding patients' perceptions of CBT-I, including a perceived strong interrelationship of sleep and pain, that patients reported an ability to improve sleep in the face of pain, and improved sleep, activities, and socialization. Patients reported that prior to CBT-I, pain intensity precluded sleep and poor sleep resulted in higher pain levels. Despite this interrelationship, patients stated they could follow essential CBT-I components and rarely identified pain as a barrier to treatment adherence. Patients reported improved sleep when following CBT-I recommendations. Although most patients did not perceive less pain intensity, they reported a substantial improvement in functioning, including increased activity ("It helped me work through the pain and do the activities I want to do") and improved socialization ("Before I was a recluse. Now I'm actually getting out and doing stuff"). Conclusion: Patients valued CBT-I for improvements in sleep, quality of life and functioning. Findings support efforts to incorporate CBT-I into chronic pain treatment, including educating patients and providers about the ability to improve sleep in the face of ongoing pain. Support (If Any): VA HSRD CDA 15-063