Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study

Chronic pain is difficult to treat and often precedes or exacerbates sleep disturbances such as insomnia. Insomnia, in turn, can amplify the pain experience. Both conditions are associated with inflammatory processes, which may be involved in the bi-directional relationship between pain and sleep. Cognitive behavioral therapy (CBT) for pain and CBT for insomnia are evidence based interventions for, respectively, chronic pain and insomnia. The study objectives were to determine the feasibility of combining CBT for pain and for insomnia and to assess the effects of the combined intervention and the stand alone interventions on pain, sleep, and mood outcomes compared to a control condition. Twenty-one adults with co-occurring chronic pain and chronic insomnia were randomized to either CBT for pain, CBT for insomnia, combined CBT for pain and insomnia, or a wait-list control condition. The combined CBT intervention was feasible to deliver and produced significant improvements in sleep, disability from pain, depression and fatigue compared to the control condition. Overall, the combined intervention appeared to have a strong advantage over CBT for pain on most outcomes, modest advantage over both CBT for insomnia in reducing insomnia severity in chronic pain patients. CBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia. ► It was feasible to combine and deliver CBT for pain and for insomnia to individuals with co-occurring pain and insomnia. ► The combined intervention was associated with large effects on sleep and depression, but minimal effects on pain. ► Compared to a control condition, CBT for insomnia (alone or in combination) significantly impacted sleep, but not pain.