The purpose of this study was to assess the long-term (six months) effects of cognitive behavioral therapy for insomnia (CBT-I) in patients with chronic pain. The results of the pre-post treatment effects have been reported previously. The therapy was delivered by an advanced practice nurse in a research setting using a parallel-group, randomized, single blind trial of CBT-I with a contact/measurement control condition. Outcomes included sleep diary, the Insomnia Severity Index, the Multidimensional Pain Inventory, the Beck Depression Inventory, the Profile of Mood States-short form, and the Pain Disability Index. Measurement time points were end-of-treatment, three-month and six-month posttherapy. Subjects receiving CBT-I , as compared to control subjects , did not exhibit any significant group by visit effects on measures of sleep, pain, mood, or function after end of treatment. However, subjects in the treatment group exhibited statistically and clinically significant improvement in total sleep time (23 minutes) over the six months following treatment. In this paper, cognitive behavioral therapy directed to improve insomnia was successfully delivered to patients with moderate-to-severe chronic pain and the positive effects of CBT-I continued to improve despite the presence of continued moderate-to-severe pain. 1. Introduction Chronic Pain is a common condition that affects the quality of life of more than 76.2 million Americans [1]. Treatments are often palliative in nature and are focused on improving function and quality of life as opposed to curative in nature. Sleep, known to be important to achieve optimal quality of life, is inevitably disturbed in the presence of pain. Approximately 53% of patients who live with chronic pain also experience sleep disturbance [2–5]. Traditionally, clinicians have indirectly addressed sleep disturbance in the presence of pain by treating the painful condition. In fact, the effectiveness of treatments for pain is often judged on a patients’ improvement in sleep. This practice seems logical, as nociceptive arousal is a precipitator and potentially a perpetuator of insomnia. But the concern is that patients may become overmedicated by the practice of titrating pain medications according to improvements in sleep as well as pain. As a clinician using cognitive behavioral interventions for insomnia (CBT-I), there is also the concern that sleep restriction may potentiate pain, or that the gains, if any, achieved from CBT-I would be short lived due to the continued nociceptive stimulation from the painful condition.
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