Approximately 50-70% of patients with chronic pain, particularly fibromyalgia sufferers, report sleep difficulties. Because it is not possible to randomly induce chronic pain or chronic insomnia in otherwise healthy participants, the exact nature of the sleep/pain relationship is not well understood. Fortunately, established cognitive behavioral treatments (CBT) treatments for insomnia (CBT-I) and pain (CBT-P) offer an excellent opportunity to examine the causal links between these two disorders. The purpose of this study is to examine the relationship between chronic pain and sleep disturbance in fibromyalgia patients. CBT-I and CBT-P will be used to examine the causal links between sleep and pain.
Specific Aims 1 and 2 involve a randomized clinical trial (RCT) to evaluate the effects on sleep and pain of CBT-I and CBT-P against a waitlist control in fibromyalgia patients with insomnia. Sleep may play an etiological role in the chronicity of chronic pain conditions. Furthermore, the maintenance of chronic pain conditions can ultimately lead to a state of central sensitization (increased responsiveness of dorsal horn neurons, and perhaps other CNS structures to stimuli).
Specific Aim 3 investigates the effect of improved sleep on central sensitization of pain, and Specific Aim 4 investigates the indirect effects of pain reduction on improvements in sleep outcomes. We propose to test specific hypotheses inherent in the Cognitive Activation Theory of stress (CAT). Sustained arousal and lack of arousal resolution (i.e., through restful sleep) has been implicated in the development of central sensitization. Also consistent with the CAT model is the hypothesis that negative affect (e.g., depression, anxiety) leads to central sensitization.
Specific Aim 5 investigates multivariate models of the relationship of pain, sleep, negative affect, and central sensitization as a test of the Cognitive Activation Theory of stress in Fibromyalgia. Both of these hypotheses are consistent with preliminary data collected in our laboratory linking both chronic pain conditions, and negative affect to central sensitization of pain in fibromyalgia patients. Public Health Relevance Paragraph: Chronic insomnia in the context of chronic pain represents a major health threat for many Americans. This research addresses the public health need for information on the relationship between chronic insomnia and chronic pain and the effect of cognitive behavioral interventions that target insomnia (CBT-I) and pain (CBT-P) in this vulnerable population. The information to be gained has broad implications not only for other patient populations likely to suffer from insomnia and pain (i.e., cancer patients), but also for those suffering from other behavioral/heath concerns (i.e., weight management, depression).

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR055160-05
Application #
8251214
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Serrate-Sztein, Susana
Project Start
2008-04-14
Project End
2014-03-31
Budget Start
2012-04-01
Budget End
2014-03-31
Support Year
5
Fiscal Year
2012
Total Cost
$308,429
Indirect Cost
$91,728
Name
University of Florida
Department
Other Health Professions
Type
Schools of Public Health
DUNS #
969663814
City
Gainesville
State
FL
Country
United States
Zip Code
32611
Miller, Mary Beth; Chan, Wai Sze; Curtis, Ashley F et al. (2018) Pain intensity as a moderator of the association between opioid use and insomnia symptoms among adults with chronic pain. Sleep Med 52:98-102
Miller, Mary Beth; Chan, Wai Sze; Boissoneault, Jeff et al. (2018) Dynamic daily associations between insomnia symptoms and alcohol use in adults with chronic pain. J Sleep Res 27:e12604
Curtis, Ashley F; Miller, Mary Beth; Boissoneault, Jeff et al. (2018) Discrepancies in sleep diary and actigraphy assessments in adults with fibromyalgia: Associations with opioid dose and age. J Sleep Res :e12746
Boissoneault, Jeff; Vatthauer, Karlyn; O'Shea, Andrew et al. (2017) Low-to-Moderate Alcohol Consumption is Associated With Hippocampal Volume in Fibromyalgia and Insomnia. Behav Sleep Med 15:438-450
Mundt, Jennifer M; Crew, Earl C; Krietsch, Kendra et al. (2016) Measuring Treatment Outcomes in Comorbid Insomnia and Fibromyalgia: Concordance of Subjective and Objective Assessments. J Clin Sleep Med 12:215-23
Vatthauer, Karlyn E; Craggs, Jason G; Robinson, Michael E et al. (2015) Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia. J Pain Res 8:819-27
McCrae, Christina S; Bramoweth, Adam D; Williams, Jacob et al. (2014) Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs. J Clin Sleep Med 10:127-35
Dautovich, Natalie D; Kay, Daniel B; Perlis, Michael L et al. (2012) Day-to-day variability in nap duration predicts medical morbidity in older adults. Health Psychol 31:671-6
Anderson, Ryan J; McCrae, Christina S; Staud, Roland et al. (2012) Predictors of clinical pain in fibromyalgia: examining the role of sleep. J Pain 13:350-8