Effectiveness of an integrated group based treatment for chronic pain and insomnia

Prevalence rates of insomnia among those who have chronic pain are high. Previous research has shown a bidirectional association between sleep and pain with the possibility that an improvement in sleep may result in an improvement in pain and other comorbid conditions such mood, anxiety and physical functioning. Although there are established cognitive behavioral therapy (CBT) programs for both chronic pain and insomnia (CBT-I), the effectiveness of integrating them has not yet been established. This study examined the effect of an integrated CBT-I and pain management program (CBT-I/P) on sleep, pain, mood, anxiety and physical function compared to the standard pain management program (treatment as usual). Method: This study involved 101 participants, attending one of 20 group pain management programs at a hospital-based pain medicine unit, who were randomly assigned to either CBT-I/P, a comparison group program or treatment as usual. A questionnaire package was administered prior to the start of the intervention, on completion, and at three-month follow up. Results: The integrated program improved sleep as measured by the Insomnia Severity Index and the Pittsburgh Sleep Disorders Questionnaire, compared to treatment as usual. There were no significant differences between groups over time in respect to other comorbid factors. However, there were significant improvements in depression, catastrophising, fear of movement and function in the CBT-I/P group. A correlational analysis showed that an improvement in sleep (regardless of which group attended) was associated with improvements in overall physical function and the ability to walk. Discussion: This study shows that a sleep intervention can be incorporated into existing pain management programs, and that doing so results in an improvement in sleep over and above what can be obtained from treatment as usual in a pain management program. This is important given the prevalence of sleep problems in patients with chronic pain. These findings also demonstrate that an improvement in sleep is associated with an improvement in quality of life factors such as mood, anxiety and physical functioning. As such, it would be beneficial to incorporate CBT-I as part of standard pain management programs