CBT for Secondary Insomnia in Chronic Pain Patients

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DESCRIPTION (provided by applicant): It is conservatively estimated that between 40 and 70 million people are affected by chronic pain and that nearly 90% of these patients complain of poor sleep. Despite high prevalence rates, very little clinical trial work has been undertaken in patients with insomnia secondary to chronic pain. We propose a preliminary study to evaluate whether CBT for insomnia can be successfully applied to insomnia secondary to chronic pain and to further assess whether clinical gains within the sleep domain are related to greater pain tolerance, improved mood and enhanced quality of life. Subjects with insomnia secondary to pain will be recruited to participate in a parallel-groups, randomized, single blind, "placebo" controlled trial. Subjects will be assigned to one of two groups: one receiving treatment (CBT for insomnia including sleep restriction, stimulus control, cognitive therapy and sleep hygiene), the other group receiving a non-active control for measurement and therapist contact time. Treatment will occur on an individual basis by a Nurse Practitioner trained in research grade CBT for Insomnia. Sleep, pain, mood and quality of life symptoms will be monitored for a 2-week baseline period, weekly during the treatment phase and for 2-week intervals at 3 and 6 months post treatment. The data obtained from this R21 will be used to create effect size estimates for 1) the efficacy of CBT-I in patients with insomnia secondary to chronic pain and 2) the effects of improved sleep continuity on pain, mood, and quality of life. It is anticipated, both on empirical and theoretical grounds, that CBT-I will produce moderate to large effects for both the primary and secondary outcome measures. If the project is successful, these data will be used as the basis for an R01 application. It is anticipated that studies of this kind will provide the kind of evidence required to make CBT-I a standard of practice for the management of chronic pain.