Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Sep 15;14(9):1595-1603.
doi: 10.5664/jcsm.7344.

Gray Matter Changes Following Cognitive Behavioral Therapy for Patients With Comorbid Fibromyalgia and Insomnia: A Pilot Study

Christina S McCrae  1 , Jennifer M Mundt  2 , Ashley F Curtis  1 , Jason G Craggs  1 , Andrew M O'Shea  3 , Roland Staud  4 , Richard B Berry  5 , William M Perlstein  3 , Michael E Robinson  3
Affiliations
Randomized Controlled Trial

Gray Matter Changes Following Cognitive Behavioral Therapy for Patients With Comorbid Fibromyalgia and Insomnia: A Pilot Study

Christina S McCrae et al. J Clin Sleep Med. .

Abstract

Study objectives: Insomnia frequently co-occurs with fibromyalgia, which is associated with gray matter atrophy. We examined the effect of cognitive behavioral therapy for insomnia (CBT-I) and pain (CBT-P) on cortical thickness.

Methods: Patients with fibromyalgia and insomnia underwent MRI before and after random assignment to CBT-I (n = 14), CBT-P (n = 16), or waitlist control (WLC; n = 7).

Results: Repeated-measures analyses of variance revealed significant interactions for two regions (left lateral orbitofrontal cortex, left rostral middle frontal, Ps < .05) and trends for four regions (right medial orbitofrontal cortex, right posterior cingulate, left caudal middle frontal, left transverse temporal; Ps < .10). Cortical thickness increased in all regions for CBT-I and decreased in five regions for CBT-P and WLC. Hierarchical regressions revealed that for the CBT-I group, reductions in wake after sleep onset were associated with an increase in cortical thickness.

Conclusions: Our pilot study presents novel evidence suggesting that CBT-I may slow or reverse cortical gray matter atrophy in patients with fibromyalgia and insomnia.

Clinical trial registration: Registry: ClinicalTrials.gov, Identifier: NCT02001077, Title: Sleep and Pain Interventions in Fibromyalgia (SPIN), URL: https://clinicaltrials.gov/ct2/show/NCT02001077.

Keywords: MRI; clinical trial; cognitive behavioral therapy; fibromyalgia; insomnia.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Study flow.
Details available from the first author upon request. CBT-I = cognitive behavioral therapy for insomnia, CBT-P = cognitive behavioral therapy for pain, WLC = waitlist control.
Figure 2
Figure 2. Cortical regions with significant or near-significant repeated-measures analysis of variance.
Figure 3
Figure 3. Effect sizes (η2p) for cortical thickness changes in each region.
Positive values indicate an increase in thickness from pretreatment to posttreatment, and negative values indicate a decrease in thickness. CBT-I = cognitive behavioral therapy for insomnia, CBT-P = cognitive behavioral therapy for pain, WLC = waitlist control.
See this image and copyright information in PMC

References

    1. Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems. Sleep. 2007;30(2):213–218. - PubMed
    1. Baker S, McBeth J, Chew-Graham CA, Wilkie R. Musculoskeletal pain and co-morbid insomnia in adults; a population study of the prevalence and impact on restricted social participation. BMC Fam Pract. 2017;18(1):17. - PMC - PubMed
    1. Roizenblatt S, Neto NSR, Tufik S. Sleep disorders and fibromyalgia. Curr Pain Headache Rep. 2011;15(5):347–357. - PubMed
    1. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3):S2–S15. - PMC - PubMed
    1. Merrigan JM, Buysse DJ, Bird JC, Livingston EH. Insomnia. JAMA. 2013;309(7):733. - PubMed

Publication types

MeSH terms

Associated data