The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain
Open accessAbstract
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 the Multidimensional Pain Inventory. The groups did not significantly differ on mood measures or measures of pain severity.Conclusions CBT-I was successfully applied to patients experiencing chronic pain. Significant improvements were found in sleep as well as in the extent to which pain interfered with daily functioning. The observed effect sizes for the sleep outcomes appear comparable to or better than meta-analytic norms for subjects with Primary Insomnia.
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RCTs of CBT-I only, with no medication comparator, generally find treatment is as efficacious in those with comorbid disorders as in those with primary insomnia.
“RCTs of CBT-I only, with no medication comparator condition, generally find that treatment is as efficacious in those with comorbid disorders compared to those with primary insomnia (for example see [38]).”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [38]
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Palliative Care Version 1.2016
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“CBT-I has demonstrated efficacy for improving sleep in adults with chronic migraine(20) and other chronic pain conditions.(21,22) However, effects on pain have been inconsistent.”
MethodAssociations Between Sleep Disturbance and Chronic Pain Intensity and Function
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Sleep Fragmentation Hypersensitizes Healthy Young Women to Deep and Superficial Experimental Pain
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Evaluation of the PHQ-9 Item 3 as a Screen for Sleep Disturbance in Primary Care
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Self-citationSleep in Patients with Chronic Migraine
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McCrae, C. S., Curtis, A. F., Williams, J. M., Dautovich, N. D., McNamara, J. P. H., Stripling, A. M., Dzierzewski, J. M., Chan, W. S., Berry, R. B., McCoy, K. J. M., et al. (2018) · Sleep Medicine · doi:10.1016/j.sleep.2018.05.018 · Cited by 64 · see citing works
“There is a growing body of empirical research which indicates that insomnia can be independently treated without the need to first resolve the comorbid condition (Jungquist et al., 2010; Morin, Kowatch, & Wade, 1989; Quesnel, Savard, Simard, Ivers, & Morin, 2003; Rybarczyk et al., 2005; Sweetman et al., 2017).”
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Nijs, J., Malfliet, A., Roose, E. C. S., Lahousse, A., Bogaert, W. V., Johansson, E., Runge, N., Goossens, Z., Labie, C., Bilterys, T., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13030644 · Cited by 63 · see citing works
“Sleep disturbances not only act as a perpetuating factor for chronic pain [60] but also are associated with depressive symptoms, functional disability, increased healthcare utilization and diminished quality of life in adolescents with chronic pain [69–71].”
BackgroundInfluentialCognitive-behavioral therapy for sleep abnormalities of chronic pain patients
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Insomnia in paediatric chronic pain and its impact on depression and functional disability
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“This idea is supported by studies on adults with chronic pain in which cognitive behavioral therapy (CBT) for insomnia has decreased both sleep problems and pain interference (Currie et al., 2000; Jungquist et al., 2010).”
ResultKnoerl, R., Smith, E., Barton, D. L., Williams, D. A., Holden, J. E., Krauss, J. C., & Lavasseur, B. I. (2017) · Journal of Pain · doi:10.1016/j.jpain.2017.11.009 · Cited by 59 · see citing works
Role of Glia in the Regulation of Sleep in Health and Disease
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“Causes of chronic pain were fibromyalgia (2 studies) [41, 43], osteoarthritis (2 studies) [45, 48], spinal pain (1 study) [42], multiple sclerosis (1 study) [39], migraine (1 study) [46], and diverse chronic pain (3 studies) [40, 44, 47].”
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“Chronic pain (CP) and insomnia each have a high prevalence and frequently co-exist (Ohayon, 2005; Tang et al., 2007; Kelly et al., 2011; Finan et al., 2013; Roberts and Drummond, 2016).”
BackgroundResultInfluentialComparative Effectiveness of Cognitive Behavioral Therapy for Insomnia: A Systematic Review
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Self-citationDisability in Patients With Chronic Neck Pain
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“A study using cognitive-behavioral therapy showed that dealing with sleep problems in patients with chronic pain may reduce painrelated disability, although it does not prominently affect pain intensity.(41) Because sleep disorder and poor mental health lead to the development of disability, adequate sleep and psychol…”
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“CBT-I improved sleep in conditions associated with traumatic injuries such as depression [13] and pain [14] in the non-Veteran population and PTSD in Veterans, including the OIF/OEF cohort [15].”
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Physiological and medical findings in insomnia: Implications for diagnosis and care
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Optimizing Cognitive Function in Persons With Chronic Pain
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Cognitive Behavioral Therapy for Insomnia in People With Chronic Disease
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The Durability of Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain
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Mobile App Use for Insomnia Self-Management: Pilot Findings on Sleep Outcomes in Veterans
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“Furthermore, CBTI has been successfully deployed in populations with comorbid health conditions [21], such as chronic pain [22-25], PTSD [17-19, 26], and depression [ 27, 28].”
Self-citationSleep Mediates the Association Between PTSD Symptoms and Chronic Pain in Youth
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“20 Buysse et al. recently published promising fi ndings in a geriatric population, where a short version of CBT-I (BBT-I) provided by NPs produced signifi cant remission in insomnia symptoms up to 6 months after treatment.”
Self-citationPainful Sleep: Insomnia in Patients with Chronic Pain Syndrome and its Consequences
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“, 1992), which was used in several investigations studying anxiety, depression or pain (Malouff et al., 1985; King and Snow, 1989; Casten et al., 1995; Lee et al., 2001; Cui et al., 2009; Jungquist et al., 2010).”
Yang, M., Liou, K. T., Garland, S. N., Bao, T., Hung, T. K. W., Li, S. Q., Li, Y., & Mao, J. J. J. (2021) · npj Breast Cancer · doi:10.1038/s41523-021-00355-0 · Cited by 31 · see citing works
- Authors
- Jungquist, C. R., O’Brien, C., Matteson-Rusby, S., Smith, M. T., Pigeon, W. R., Xia, Y., Lu, N., & Perlis, M. L.
- Affiliations
- University of Rochester Medicine (US)
- Johns Hopkins University (US)
- University of Rochester (US)
- University of Pennsylvania (US)
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 11
- Issue
- 3
- Pages
- 302-309
- ISSN
- 1389-9457 (ISSN-L)
- PMC
- PMC2830371
- OpenAlex
- W2101759370
- Cited by
- 256
- References
- 27
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 12 · 2023: 9 · 2022: 20 · 2021: 22 · 2020: 13 · 2019: 22 · 2018: 13 · 2017: 17 · 2016: 16 · 2015: 25 · 2014: 23 · 2013: 11 · 2012: 21
- FWCI
- 20.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (L30 MH087269)
- National Institute of Nursing Research (NR5R21NR009080-02., R21NR009080)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy for insomnia, chronic pain, insomnia, neck pain, back pain, sleep restriction, stimulus control, sleep hygiene, catastrophic thinking, pain interference, sleep efficiency, mood
- MeSH terms
- Adult, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Medical Records, Middle Aged, Pain, Pain Measurement, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome
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