Sleep Medicine 11 (2010) 302–309

Contents lists available at ScienceDirect

Sleep Medicine journal homepage: www.elsevier.com/locate/sleep

Original Article

The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain
Carla R. Jungquist a,b,c,*, Chris O’Brien a,c, Sara Matteson-Rusby c, Michael T. Smith d, Wilfred R. Pigeon c, Yinglin Xia e, Naiji Lu e, Michael L. Perlis f,* a University of Rochester, School of Nursing, NY, USA University of Rochester, Department of Anesthesiology, NY, USA University of Rochester, Sleep and Neurophysiology Research Laboratory, NY, USA d John Hopkins University, Department of Psychiatry and Behavioral Sciences, MD, USA e University of Rochester, Department of Biostatistics, NY, USA f University of Pennsylvania, Department of Psychiatry, PA, USA b c

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Study objectives: To assess the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in patients with non-malignant chronic pain. Methods: Twenty-eight subjects with chronic neck and back pain were stratified according to gender, age, and ethnicity, then assigned to one of the two treatment groups: CBT-I or a contact control condition. Intervention: Eight weeks of CBT-I including sleep restriction, stimulus control, sleep hygiene, and one session of cognitive therapy devoted to catastrophic thoughts about the consequences of insomnia. Measurements and results: Outcomes included sleep diary assessments of sleep continuity, pre–post measures of insomnia severity (ISI), pain (Multidimensional Pain Inventory), and mood (BDI and POMS). Subjects receiving CBT-I (n = 19), as compared to control subjects (n = 9), exhibited significant decreases in sleep latency, wake after sleep onset, number of awakenings, and significant increase in sleep efficiency. The diary findings were paralleled by significant changes in the ISI (p = 0.05). Significant improvement (p = 0.03) was found on the Interference Scale of