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
. 2019 Mar 1;42(3):zsy234.
doi: 10.1093/sleep/zsy234.

Cognitive behavioral treatments for insomnia and pain in adults with comorbid chronic insomnia and fibromyalgia: clinical outcomes from the SPIN randomized controlled trial

Christina S McCrae  1 , Jacob Williams  2 , Daniela Roditi  2 , Ryan Anderson  2 , Jennifer M Mundt  2 , Mary Beth Miller  1 , Ashley F Curtis  1 , Lori B Waxenberg  2 , Roland Staud  3 , Richard B Berry  4 , Michael E Robinson  2
Affiliations
Randomized Controlled Trial

Cognitive behavioral treatments for insomnia and pain in adults with comorbid chronic insomnia and fibromyalgia: clinical outcomes from the SPIN randomized controlled trial

Christina S McCrae et al. Sleep. .

Abstract

Study objectives: To examine the effects of cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in patients with comorbid fibromyalgia and insomnia.

Methods: One hundred thirteen patients (Mage = 53, SD = 10.9) were randomized to eight sessions of CBT-I (n = 39), CBT-P (n = 37), or a waitlist control (WLC, n = 37). Primary (self-reported sleep onset latency [SOL], wake after sleep onset [WASO], sleep efficiency [SE], sleep quality [SQ], and pain ratings) and secondary outcomes (dysfunctional beliefs and attitudes about sleep [DBAS]; actigraphy and polysomnography SOL, WASO, and SE; McGill Pain Questionnaire; Pain Disability Index; depression; and anxiety) were examined at posttreatment and 6 months.

Results: Mixed effects analyses revealed that both treatments improved self-reported WASO, SE, and SQ relative to control at posttreatment and follow-up, with generally larger effect sizes for CBT-I. DBAS improved in CBT-I only. Pain and mood improvements did not differ by group. Clinical significance analyses revealed the proportion of participants no longer reporting difficulties initiating and maintaining sleep was higher for CBT-I posttreatment and for both treatments at 6 months relative to control. Few participants achieved >50% pain reductions. Proportion achieving pain reductions of >30% (~1/3) was higher for both treatments posttreatment and for CBT-I at 6 months relative to control.

Conclusions: CBT-I and CBT-P improved self-reported insomnia symptoms. CBT-I prompted improvements of larger magnitude that were maintained. Neither treatment improved pain or mood. However, both prompted clinically meaningful, immediate pain reductions in one third of patients. Improvements persisted for CBT-I, suggesting that CBT-I may provide better long-term pain reduction than CBT-P. Research identifying which patients benefit and mechanisms driving intervention effects is needed.

Clinical trial: Sleep and Pain Interventions in Fibromyalgia (SPIN), clinicaltrials.gov, NCT02001077.

Keywords: CBT; cognitive behavioral treatments; comorbid chronic insomnia; fibromyalgia; pain; sleep.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Participant recruitment CONSORT-style flow diagram. Allocated = randomized. Received intervention = completing all 8 sessions treatment sessions. *Details available from the first author upon request.
Figure 2.
Figure 2.
Within-group change in outcomes at posttreatment and 6 month assessments.
Figure 3.
Figure 3.
Percentage of participants no longer reporting difficulties initiating and maintaining sleep at posttreatment and 6 month assessments.
Figure 4.
Figure 4.
Percentage of participants reporting clinically significant improvements in pain at posttreatment and 6 month assessments.
See this image and copyright information in PMC

References

    1. Theadom A, et al. . Exploring the role of sleep and coping in quality of life in fibromyalgia. J Psychosom Res. 2007;62(2):145–151. - PubMed
    1. White KP, et al. . The London Fibromyalgia Epidemiology study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls. J Rheumatol. 1999;26(7):1577–1585. - PubMed
    1. Lawrence RC, et al. ; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26–35. - PMC - PubMed
    1. Spaeth M. Epidemiology, costs, and the economic burden of fibromyalgia. Arthritis Res Ther. 2009;11(3):117. - PMC - PubMed
    1. Finan PH, et al. . The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539–1552. - PMC - PubMed

Publication types

MeSH terms

Associated data