Cognitive-Behavioral Treatment for Comorbid Insomnia and Osteoarthritis Pain in Primary Care: The Lifestyles Randomized Controlled Trial

• Published in: Journal of the American Geriatrics Society (JAGS) 2013-06, Vol.61 (6), p.947-956
• Main Authors: Vitiello, Michael V., McCurry, Susan M., Shortreed, Susan M., Balderson, Benjamin H., Baker, Laura D., Keefe, Francis J., Rybarczyk, Bruce D., Von Korff, Michael
• Format: Article
• Language: English
• Subjects: Aged; aging; Arthralgia - diagnosis; Arthralgia - etiology; Arthralgia - therapy; Arthritis; Biological and medical sciences; Clinical outcomes; Cluster Analysis; Cognitive therapy; Cognitive Therapy - methods; cognitive-behavioral therapy; Comorbidity; Diseases of the osteoarticular system; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Double-Blind Method; Female; Follow-Up Studies; General aspects; Geriatrics; Humans; Insomnia; Life Style; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Older people; Osteoarthritis; Osteoarthritis - complications; Osteoarthritis - therapy; pain; Pain management; Pain Measurement; Retrospective Studies; Sleep; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - physiopathology; Sleep Initiation and Maintenance Disorders - therapy; Time Factors; Treatment Outcome
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.12275

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