Cognitive-behavioral therapy for comorbid insomnia and chronic pain

Research output: Contribution to journalArticle

Abstract

Insomnia and chronic pain harbor a high rate of comorbidity, and have been regarded as reciprocally related conditions. Four RCTs have investigated the efficacy of CBT-I and 2 RCTs have investigated the efficacy of hybrid CBT-I/CBT-P interventions in reducing insomnia and pain symptoms. In general, these interventions demonstrate clinically meaningful improvements in sleep symptoms. Improvements in pain-related outcomes have been observed in functional domains, such as pain interference and disability, with limited evidence supporting the short-term efficacy of CBT-I or hybrid interventions for pain severity. Hybrid interventions are feasible, and one large-scale RCT now supports the findings of 2 pilot studies, suggesting that hybrid interventions, as currently designed, improve sleep, but not pain severity. Future clinical trials should consider using more comprehensive pain assessments with longer-term follow-up assessment of at least 1 year or more. Measurement strategies that permit the analysis of time-variant contingencies in sleep, pain, and associated psychosocial variables may also be particularly informative. Larger-scale investigations are needed to clarify the limited efficacy data from the small pilot RCTs on hybrid interventions. Future studies aimed at developing hybrid interventions should be designed to investigate issues related to the sequencing of pain and sleep components, and should address the trade-off between the number of new skills patients are expected to master and the quality and mastery of critical components. Hybrid approaches that combine sleep and pain intervention components continue to hold promise for improving the treatment of chronic pain among patients with comorbid insomnia.

Original languageEnglish (US)
Pages (from-to)261-274
Number of pages14
JournalSleep Medicine Clinics
Volume9
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Sleep Initiation and Maintenance Disorders
Cognitive Therapy
Chronic Pain
Pain
Sleep
Pain Measurement
Comorbidity
Clinical Trials

Keywords

  • Chronic pain
  • Cognitive-behavioral therapy for insomnia
  • Comorbid
  • Insomnia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Neuropsychology and Physiological Psychology
  • Clinical Psychology
  • Clinical Neurology

Cite this

Cognitive-behavioral therapy for comorbid insomnia and chronic pain. / Finan, Patrick Hamilton; Buenaver, Luis F; Runko, Virginia T.; Smith, Michael T.

In: Sleep Medicine Clinics, Vol. 9, No. 2, 2014, p. 261-274.

Research output: Contribution to journalArticle

@article{7ee8624f33e3487193de19246000f5e2,
title = "Cognitive-behavioral therapy for comorbid insomnia and chronic pain",
abstract = "Insomnia and chronic pain harbor a high rate of comorbidity, and have been regarded as reciprocally related conditions. Four RCTs have investigated the efficacy of CBT-I and 2 RCTs have investigated the efficacy of hybrid CBT-I/CBT-P interventions in reducing insomnia and pain symptoms. In general, these interventions demonstrate clinically meaningful improvements in sleep symptoms. Improvements in pain-related outcomes have been observed in functional domains, such as pain interference and disability, with limited evidence supporting the short-term efficacy of CBT-I or hybrid interventions for pain severity. Hybrid interventions are feasible, and one large-scale RCT now supports the findings of 2 pilot studies, suggesting that hybrid interventions, as currently designed, improve sleep, but not pain severity. Future clinical trials should consider using more comprehensive pain assessments with longer-term follow-up assessment of at least 1 year or more. Measurement strategies that permit the analysis of time-variant contingencies in sleep, pain, and associated psychosocial variables may also be particularly informative. Larger-scale investigations are needed to clarify the limited efficacy data from the small pilot RCTs on hybrid interventions. Future studies aimed at developing hybrid interventions should be designed to investigate issues related to the sequencing of pain and sleep components, and should address the trade-off between the number of new skills patients are expected to master and the quality and mastery of critical components. Hybrid approaches that combine sleep and pain intervention components continue to hold promise for improving the treatment of chronic pain among patients with comorbid insomnia.",
keywords = "Chronic pain, Cognitive-behavioral therapy for insomnia, Comorbid, Insomnia",
author = "Finan, {Patrick Hamilton} and Buenaver, {Luis F} and Runko, {Virginia T.} and Smith, {Michael T}",
year = "2014",
doi = "10.1016/j.jsmc.2014.02.007",
language = "English (US)",
volume = "9",
pages = "261--274",
journal = "Sleep Medicine Clinics",
issn = "1556-407X",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Cognitive-behavioral therapy for comorbid insomnia and chronic pain

AU - Finan, Patrick Hamilton

AU - Buenaver, Luis F

AU - Runko, Virginia T.

AU - Smith, Michael T

PY - 2014

Y1 - 2014

N2 - Insomnia and chronic pain harbor a high rate of comorbidity, and have been regarded as reciprocally related conditions. Four RCTs have investigated the efficacy of CBT-I and 2 RCTs have investigated the efficacy of hybrid CBT-I/CBT-P interventions in reducing insomnia and pain symptoms. In general, these interventions demonstrate clinically meaningful improvements in sleep symptoms. Improvements in pain-related outcomes have been observed in functional domains, such as pain interference and disability, with limited evidence supporting the short-term efficacy of CBT-I or hybrid interventions for pain severity. Hybrid interventions are feasible, and one large-scale RCT now supports the findings of 2 pilot studies, suggesting that hybrid interventions, as currently designed, improve sleep, but not pain severity. Future clinical trials should consider using more comprehensive pain assessments with longer-term follow-up assessment of at least 1 year or more. Measurement strategies that permit the analysis of time-variant contingencies in sleep, pain, and associated psychosocial variables may also be particularly informative. Larger-scale investigations are needed to clarify the limited efficacy data from the small pilot RCTs on hybrid interventions. Future studies aimed at developing hybrid interventions should be designed to investigate issues related to the sequencing of pain and sleep components, and should address the trade-off between the number of new skills patients are expected to master and the quality and mastery of critical components. Hybrid approaches that combine sleep and pain intervention components continue to hold promise for improving the treatment of chronic pain among patients with comorbid insomnia.

AB - Insomnia and chronic pain harbor a high rate of comorbidity, and have been regarded as reciprocally related conditions. Four RCTs have investigated the efficacy of CBT-I and 2 RCTs have investigated the efficacy of hybrid CBT-I/CBT-P interventions in reducing insomnia and pain symptoms. In general, these interventions demonstrate clinically meaningful improvements in sleep symptoms. Improvements in pain-related outcomes have been observed in functional domains, such as pain interference and disability, with limited evidence supporting the short-term efficacy of CBT-I or hybrid interventions for pain severity. Hybrid interventions are feasible, and one large-scale RCT now supports the findings of 2 pilot studies, suggesting that hybrid interventions, as currently designed, improve sleep, but not pain severity. Future clinical trials should consider using more comprehensive pain assessments with longer-term follow-up assessment of at least 1 year or more. Measurement strategies that permit the analysis of time-variant contingencies in sleep, pain, and associated psychosocial variables may also be particularly informative. Larger-scale investigations are needed to clarify the limited efficacy data from the small pilot RCTs on hybrid interventions. Future studies aimed at developing hybrid interventions should be designed to investigate issues related to the sequencing of pain and sleep components, and should address the trade-off between the number of new skills patients are expected to master and the quality and mastery of critical components. Hybrid approaches that combine sleep and pain intervention components continue to hold promise for improving the treatment of chronic pain among patients with comorbid insomnia.

KW - Chronic pain

KW - Cognitive-behavioral therapy for insomnia

KW - Comorbid

KW - Insomnia

UR - http://www.scopus.com/inward/record.url?scp=84901721662&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901721662&partnerID=8YFLogxK

U2 - 10.1016/j.jsmc.2014.02.007

DO - 10.1016/j.jsmc.2014.02.007

M3 - Article

C2 - 25477769

AN - SCOPUS:84901721662

VL - 9

SP - 261

EP - 274

JO - Sleep Medicine Clinics

JF - Sleep Medicine Clinics

SN - 1556-407X

IS - 2

ER -