Document Detail

Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial.
MedLine Citation:
PMID:  23711168     Owner:  NLM     Status:  MEDLINE    
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: Group Health and University of Washington, 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.
Michael V Vitiello; Susan M McCurry; Susan M Shortreed; Benjamin H Balderson; Laura D Baker; Francis J Keefe; Bruce D Rybarczyk; Michael Von Korff
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2013-05-27
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  61     ISSN:  1532-5415     ISO Abbreviation:  J Am Geriatr Soc     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-06-18     Completed Date:  2013-09-03     Revised Date:  2013-12-04    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  947-56     Citation Subset:  IM    
Copyright Information:
© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
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MeSH Terms
Arthralgia / diagnosis,  etiology,  therapy*
Cluster Analysis
Cognitive Therapy / methods*
Double-Blind Method
Follow-Up Studies
Life Style*
Middle Aged
Osteoarthritis / complications,  therapy*
Pain Measurement
Retrospective Studies
Sleep Initiation and Maintenance Disorders / complications,  physiopathology,  therapy*
Time Factors
Treatment Outcome
Grant Support
R01 AG031126/AG/NIA NIH HHS; R01-AG031126/AG/NIA NIH HHS

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