Clinical Question

Can cognitive behavior therapy (CBT) for insomnia in patients with chronic pain be effectively delivered via telephone?

Bottom Line

In patients with clinical insomnia and chronic pain, CBT for insomnia delivered via telephone over six sessions leads to relief of sleeplessness that is sustained for at least one year. In this study, general education also provided insomnia relief to many patients. (Level of Evidence = 1b−)

Synopsis

The researchers recruited 327 participants with moderate to severe osteoarthritis and clinical insomnia identified via telephone screening. The patients had not sought care but had a positive screen for insomnia with an average score on the Insomnia Severity Index of 15.5 out of a possible 28. Most participants were women (75%) and White (96%), and almost one-half (48%) were college graduates. The patients were randomized (allocation concealment unknown) to receive telephone-based CBT for insomnia (focused on in-bed restriction, cognitive strategies to reduce hyperarousal, and setting realistic sleep expectations) or an education-only intervention. All participants were contacted six times by telephone over eight weeks. Two months after the end of the treatment period, insomnia scores decreased by 8.1 points in the CBT group and 4.8 points in the education-only group (P = .001); 81% of the CBT group had at least a 30% improvement in insomnia scores compared with 49% of the education group (P < .001). Differences in scores were maintained 12 months after treatment. Feelings of fatigue improved to a greater extent with CBT.

Study design: Randomized controlled trial (nonblinded)

Funding source: Industry and foundation

Allocation: Uncertain

Setting: Inpatient (any location)

Reference: McCurry SM, Zhu W, Von Korff M, et al. Effect of telephone cognitive behavioral therapy for insomnia in older adults with osteoarthritis pain: a randomized clinical trial. JAMA Intern Med. 2021;181(4):530–538.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.