A Clinical Intervention in Chronic Pain and Insomnia with a Combined Model of Treatment: A Test of Concept

Abstract

Co-occurring chronic pain and insomnia are common in a clinical setting. Cognitive–behavioral theoretical (CBT) frameworks exist for both conditions independently. The purpose of this study was to address the problem of co-occurring chronic pain and insomnia with an integrated CBT model based on empirical support. One-hundred eleven individuals (age range 21–65 years) meeting the general criteria for chronic pain and insomnia were included in this study. Participants completed a demographic form, the Dysfunctional Beliefs and Attitudes about Sleep—16-item version, Insomnia Severity Index, Sleep Hygiene Index, Sleep Associated Monitoring Index, Pain Catastrophizing Scale, Pain Disability Questionnaire, Modified Somatic Perceptions Questionnaire, Hospital Anxiety and Depression Scale, and Multidimensional Scale of Perceived Social Support. Significant positive bivariate relationships were observed for pain catastrophizing (PC) and dysfunctional beliefs and attitudes about sleep (DBAS), as well as somatic awareness and sleep-associated monitoring. Two backward stepwise regression models were utilized to determine a model for predicting insomnia severity and pain disability respectively using a combination of sleep and pain-associated measures. Insomnia severity was predicted by DBAS, PC, and somatic awareness. Pain disability was predicted by PC, DBAS, depression, and social support. Maladaptive thought patterns related to pain and insomnia and associated features appear to have a synergistic effect on both insomnia severity and pain disability and support a combined cognitive–behavioral model.