Cognitive behavioral therapy effective for insomnia and chronic pain

Delivery of treatment by nurses can give access to more people

Cognitive behavioral therapy for insomnia significantly improved sleep for patients with chronic neck or back pain and also reduced the extent to which pain interfered with their daily functioning, according to a study by University of Rochester Medical Center researchers.

The study, published online by the journal Sleep Medicine, demonstrates that a behavioral intervention can help patients who already are taking medications for pain and might be reluctant or unable to take additional drugs to treat sleep disturbance.

"This therapy made a major difference to these patients," said Carla R. Jungquist, F.N.P., Ph.D., of the Medical Center's Sleep and Neurophysiology Research Laboratory, who is the lead author of the Sleep Medicine article. "We saw very good treatment effects."

For the study, a nurse therapist delivered the eight weeks of cognitive behavioral therapy, which included sleep restriction, stimulus control, sleep hygiene, and one session devoted to discussion of catastrophic thoughts about the consequences of insomnia.

"This study really shows that this therapy can be delivered successfully and very effectively by advance practice nurses," Jungquist said. "Training nurses in the delivery of this type of therapy will result in better access for patients. Currently, access to this therapy is limited as there are few trained therapists and most are psychologists."

Patients with chronic pain often use sleep as an escape. They seek sleep when not sleepy, sleep in places other than the bedroom, and engage in non-sleep behaviors, such as watching television and resting a painful back, in the bedroom, the researchers report.

Using behavioral therapy instead of adding to their list of medications is a healthier and safer method of treating sleep disturbance, Jungquist said.

"We establish a structure for the times or hours spent in bed," Jungquist explained. "We focus on a patient's negative thoughts about sleep and address unhealthy sleep behavior. We address habits, including use of caffeine or alcohol. We tell people to do nothing in bed except sleep or [Bleep]."

Twenty-eight patients took part in the study. They were tracked through detailed sleep diaries. Their pain and mood were measured using several standard methods throughout the study period. The patients were followed for six months after treatment. Researchers expect to report soon on the duration of the effects of the treatment.

The researchers believe that cognitive behavioral therapy is as effective as other tested treatments for insomnia and chronic pain and, in some cases, is more effective than other therapies.

The researchers have developed a unique, user-friendly manual that described each step of every treatment session. It can be used to train more therapists.