Comorbid chronic pain and insomnia affects the quality of life and functioning of millions of Veterans across service eras. Cognitive behavioral therapy for insomnia (CBT-I) is a highly effective and safe treatment for improving sleep and pain outcomes, yet is severely underutilized among patients with chronic pain. Evidence suggests that even if patients with chronic pain initiate CBT-I, they have difficulty adhering to treatment recommendations due to pain-specific barriers. To ensure more patients with chronic pain can benefit from CBT-I, evidence-based strategies are needed to increase referrals, patient initiation, patient retention and adherence to CBT-I treatment recommendations.
The goal of the proposed research is to maximize the benefit of CBT-I for patients with chronic pain and insomnia. Aim 1 focuses on understanding the experience of sleep treatment in comorbid chronic pain and insomnia to inform strategies to eliminate barriers to adherence. Aim 2 focuses on optimizing CBT-I delivery for patients with chronic pain and insomnia by developing and pilot testing a package of adaptations to enhance CBT-I adherence. Aim 3 focuses on increasing demand for CBT-I among patients with chronic pain and their providers by developing and testing implementation strategies to increase awareness and positive attitudes toward CBT-I.
Aim 1 will be achieved using a qualitative study with patient and CBT-I provider dyads following completion or drop-out from CBT-I to understand the experience of sleep treatment in comorbid chronic pain and insomnia. These findings will inform the development of an adherence package to be added to standard CBT-I. Aim 2 will be achieved by testing this initial adherence package in a local pilot feasibility study with CBT-I providers delivering CBT-I with the adherence package to 20 patients with chronic pain. Following this pilot, we plan to submit an HSR&D Investigator Initiated Research (IIR) proposal for a pragmatic randomized clinical trial of the adherence package. Aim 3 will be achieved by conducting a local implementation study to test a social marketing campaign targeting patients with chronic pain and their providers to increase use and engagement with CBT-I.
Not yet available.
Addressing barriers to full implementation of CBT-I for patients with chronic pain will greatly enhance the quality of life for many Veterans. Although this CDA is focused on a high-risk population of patients with chronic pain, we expect that findings will have a broad impact on CBT-I dissemination and adherence for all patients with insomnia. Since adherence to cognitive-behavioral therapies is a widespread problem within the mental health field, this research also has the potential to inform future efforts to increase adherence to other evidence-based therapies for pain, depression, and anxiety.
- Koffel E, Amundson E, Polusny G, Wisdom JP. "You're Missing Out on Something Great": Patient and Provider Perspectives on Increasing the Use of Cognitive Behavioral Therapy for Insomnia. Behavioral sleep medicine. 2019 Mar 24; 1-14.
- Koffel E, McCurry SM, Smith MT, Vitiello MV. Improving pain and sleep in middle-aged and older adults: the promise of behavioral sleep interventions. Pain. 2019 Mar 1; 160(3):529-534.