Treatment of Insomnia Secondary to Chronic Pain

This study has been completed.
Sponsor:
Collaborators:
Information provided by (Responsible Party):
Wilfred Pigeon, University of Rochester
ClinicalTrials.gov Identifier:
NCT00127790
First received: August 3, 2005
Last updated: September 14, 2012
Last verified: September 2012
  Purpose

Several studies have shown that behavioral therapy for chronic pain can be beneficial for chronic pain and that behavioral therapy for insomnia can be beneficial for insomnia. However, seldom do chronic pain patients with insomnia receive a behavioral treatment for insomnia. The purpose of this study is to evaluate whether treatment for insomnia is helpful for pain and whether treatment for pain is helpful for insomnia. It will also assess whether a combined treatment is any more or less effective for pain or for sleep. Finally, the study will assess whether any of these treatments leads to improvements in immune function.


Condition Intervention
Insomnia
Pain
Behavioral: CBT for Insomnia (CBT-I)
Behavioral: CBT for Pain (CBT-P)

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: CBT for Co-Morbid Insomnia and Chronic Pain: Sleep, Pain and Immune Function Outcomes

Resource links provided by NLM:


Further study details as provided by University of Rochester:

Primary Outcome Measures:
  • Insomnia Severity [ Time Frame: Pre to Post Treatment Change (Over an average of approximately 10 weeks) ] [ Designated as safety issue: No ]
    Total Score from the 7-item Insomnia Severity Index where total score ranges from 0-28 and higher scores indicate greater severity of insomnia.

  • Pain Severity [ Time Frame: Pre to Post Treatment Change (Over an average of approximately 10 weeks) ] [ Designated as safety issue: No ]
    Multidimensional Pain Inventory - Pain Severity SubScale score. The subscale consists of 3 items with a total subscale score ranging from 0-18 with higher values indicating greater pain severity.

  • IL-6 [ Time Frame: Pre to Post Treatment Change (Over an average of approximately 10 weeks) ] [ Designated as safety issue: No ]
    Circulating levels of Interleukin-6 (IL-6)from plasma drawn in the morning. Values are presented as picograms per milliliter (pg/mL) and can range from 0 to 500, though tend to be in the range of 0-10. Higher values indicate higher amounts of circulating levels of IL-6, a marker of increased inflammatory processes.


Secondary Outcome Measures:
  • Depression Severity [ Time Frame: Pre to Post Treatment Chnage (Over an average of approximately 10 weeks) ] [ Designated as safety issue: No ]
    Total score from the 20-item Center for Epidemiologic Studies Depression Scale-revised where the total score ranges from 0-60 and higher scores indicate greater depression severity.


Enrollment: 28
Study Start Date: June 2005
Study Completion Date: November 2008
Primary Completion Date: October 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: CBT for Insomnia (CBT-I)
Cognitive-Behavioral Therapy for Insomnia (CBT-I)consisting of 10 individual sessions and including sleep education, sleep restriction therapy, stimulus control therapy, sleep hygiene, cognitive therapy, relaxation training and relapse prevention.
Behavioral: CBT for Insomnia (CBT-I)
Other Name: Cognitive-Behavioral Therapy for Insomnia (CBT-I)
Active Comparator: CBT for Pain (CBT-P)
Cognitive-Behavioral Therapy for Pain (CBT-P)consisting of 10 individual sessions and including pain education, pacing strategies, problem solving, goal setting, cognitive therapy, relaxation training and relapse prevention.
Behavioral: CBT for Pain (CBT-P)
Other Name: Cognitive-Behavioral Therapy for Pain (CBT-P)
Experimental: CBT for Insomnia & Pain (CBT-I/P)
Combined Cognitive-Behavioral Therapy for Insomnia & Cognitive-Behavioral Therapy for Pain (CBT-I/P)over 10 individual sessions.
Behavioral: CBT for Insomnia (CBT-I)
Other Name: Cognitive-Behavioral Therapy for Insomnia (CBT-I)
Behavioral: CBT for Pain (CBT-P)
Other Name: Cognitive-Behavioral Therapy for Pain (CBT-P)
No Intervention: Wait-List Control (WL)
Waitlist Control condition (WL) with no contact during the intervention period.

Detailed Description:

The investigators' primary goal is to assess the extent to which three forms of cognitive-behavioral treatment (CBT for insomnia, CBT for pain, and combined insomnia & pain) diminishes insomnia symptoms in patients with chronic pain compared to a group not receiving CBT. This will be evaluated in a randomized trial with before and after evaluations using standard sleep diary measures of sleep continuity.

The investigators' secondary goal is to assess whether treatment responses to any of the interventions are associated with alterations in immune function.

The investigators' tertiary goals are to evaluate whether improved sleep has effects on patient reports of pain severity, frequency, and tolerability as well as on mood and quality of life.

  Eligibility

Ages Eligible for Study:   35 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Ages 35-75
  • Chronic non-malignant painful condition of the spine of > 6 months duration
  • Insomnia (> 30 minutes sleep latency and/or wake after sleep onset time for > 3 days/week for > 6 months)
  • Insomnia developed after the onset of the painful condition
  • Preferred sleep phase between 10:00 p.m. and 8:00 am
  • On stable medical regimen for medical and pain conditions (no surgery planned)
  • Willingness to discontinue hypnotic medications

Exclusion Criteria:

  • Unstable medical or psychiatric illness
  • History of seizures
  • Evidence of active illicit substance use or fitting criteria for ethanol (ETOH) abuse or dependence
  • Symptoms suggestive of sleep disorders other than insomnia
  • Polysomnographic data indicating sleep disorders other than insomnia
  • Inadequate language comprehension
  • Fibromyalgia
  • Pregnancy
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00127790

Locations
United States, New York
University of Rochester Sleep Research Laboratory
Rochester, New York, United States, 14642
Sponsors and Collaborators
University of Rochester
Investigators
Principal Investigator: Wilfred R. Pigeon, Ph.D University of Rochester
  More Information

No publications provided

Responsible Party: Wilfred Pigeon, Asst Prof, University of Rochester
ClinicalTrials.gov Identifier: NCT00127790     History of Changes
Other Study ID Numbers: 160743209, F32NS049789, K23NR010408, R21AG023956; R24AG031089
Study First Received: August 3, 2005
Results First Received: June 12, 2012
Last Updated: September 14, 2012
Health Authority: United States: Institutional Review Board

Keywords provided by University of Rochester:
Insomnia
Sleep
Pain
Pain, Chronic
Behavior Therapy
CBT
CBT-I
cognitive-behavioral

Additional relevant MeSH terms:
Chronic Pain
Pain
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms

ClinicalTrials.gov processed this record on September 18, 2014