This is a revised submission of 1 R01 AG031126-01, Cognitive Behavioral Therapy for Arthritis Pain and Insomnia in Older Adults. Osteoarthritis (OA) pain affects half of all adults age 60 or older;the majority of whom also experience significant sleep disturbance. Since pain initiates and exacerbates sleep disturbance and poor sleep in turn maintains and exacerbates chronic pain, optimal interventions for OA should target both pain and sleep. While there is limited preliminary evidence that such an intervention may benefit both pain and sleep, a large, rigorous randomized controlled trial testing this hypothesis is lacking. The proposed study will determine whether an intervention that targets both pain and co-morbid sleep disturbance in older adults with painful OA and disturbed sleep yields substantially improved pain, sleep and functional outcomes relative to both an intervention targeting pain alone and a placebo-control. Older (>60 yrs) patients (N=5556 in current database) who have sought treatment for OA in a large health plan will be screened for significant chronic pain and co-morbid sleep disturbance. Three hundred seventy five patients will be randomized to one of three treatment groups: an 8-session Cognitive-Behavioral Therapy for Pain (CBT-P) program addressing pain dysfunction alone;an 8-session Cognitive-Behavioral Therapy for Pain and Insomnia (CBT- Principal Investigator) program addressing both pain and sleep disturbance;{or an 8-session Stress Management and Wellness (SMW) placebo-control group. The SMW condition is based on a placebo-control intervention previously demonstrated to have no effect on sleep quality or perceived pain. To control relevant information, all three groups (CBT-P, CBT-Principal Investigator and SMW) will receive the Arthritis Helpbook, which provides information on pain control, arthritis self-management, and sleep hygiene techniques. Subjects will be assessed at baseline, post-treatment (2-months) and at 6, 12 and 24-month follow-ups. We hypothesize that: 1) CBT-Principal Investigator will produce significantly greater initial and long-term improvements in sleep outcomes relative to both CBT-P and SMW;2) CBT-Principal Investigator, by improving sleep outcomes, will produce significantly greater initial and long-term reductions in OA pain than both CBT-P and SMW;3) CBT-Principal Investigator, by improving both sleep and pain outcomes, will produce greater initial and long-term improvements in pain-related activity limitations than both CBP-P and SMW;} and 4) CBT-Principal Investigator, by improving sleep, pain and functional outcomes, will produce long-term reductions in health care utilization and costs for a broad range of symptomatic conditions (including pain and sleep disturbance). The proposed trial will also provide the largest experimental evaluation to date assessing the effectiveness of conventional CBT for OA pain. Given recent limitations on pharmacologic options for management of OA pain, the proposed trial has important implications for improving management of both pain and co-morbid sleep disturbance in the rapidly growing population of older Americans with OA.

Public Health Relevance

Osteoarthritis (OA) pain debilitates half of all older adults, most of whom also experience significant sleep disturbance. This project will determine whether a cognitive-behavioral treatment targeting both pain and co- morbid sleep disturbance in older adults with painful OA results in substantially greater reductions in pain and improvements in sleep and functional outcomes compared to current standards of care. Given the recent limitations on pharmacologic options for effective management of OA pain, this project has major implications for improving management of both pain and co-morbid sleep disturbance in the rapidly growing population of older Americans suffering from OA.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG031126-04
Application #
8113960
Study Section
Psychosocial Risk and Disease Prevention Study Section (PRDP)
Program Officer
Mackiewicz, Miroslaw
Project Start
2008-09-01
Project End
2013-07-31
Budget Start
2011-08-01
Budget End
2012-07-31
Support Year
4
Fiscal Year
2011
Total Cost
$591,448
Indirect Cost
Name
University of Washington
Department
Psychiatry
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Koffel, Erin; Vitiello, Michael V; McCurry, Susan M et al. (2018) Predictors of Adherence to Psychological Treatment for Insomnia and Pain: Analysis from a Randomized Trial. Clin J Pain 34:375-382
Liu, Minhui; McCurry, Susan M; Belza, Basia et al. (2018) Effects of Pain, Insomnia, and Depression on Psychoactive Medication Supply in Older Adults With Osteoarthritis. Med Care 56:1024-1031
Liu, Minhui; McCurry, Susan M; Belza, Basia et al. (2018) Effects of Osteoarthritis Pain, and Concurrent Insomnia and Depression on Health Care Use in a Primary Care Population of Older Adults. Arthritis Care Res (Hoboken) :
Tang, Hsin-Yi Jean; McCurry, Susan M; Pike, Kenneth C et al. (2017) Differential predictors of nighttime and daytime sleep complaints in older adults with comorbid insomnia and osteoarthritis pain. J Psychosom Res 100:22-28
Balderson, Benjamin H; McCurry, Susan M; Vitiello, Michael V et al. (2016) Information without Implementation: A Practical Example for Developing a Best Practice Education Control Group. Behav Sleep Med 14:514-27
Vitiello, Michael V; McCurry, Susan M; Shortreed, Susan M et al. (2014) Short-term improvement in insomnia symptoms predicts long-term improvements in sleep, pain, and fatigue in older adults with comorbid osteoarthritis and insomnia. Pain 155:1547-54
Gooneratne, Nalaka S; Vitiello, Michael V (2014) Sleep in older adults: normative changes, sleep disorders, and treatment options. Clin Geriatr Med 30:591-627
McCurry, Susan M; Shortreed, Susan M; Von Korff, Michael et al. (2014) Who benefits from CBT for insomnia in primary care? Important patient selection and trial design lessons from longitudinal results of the Lifestyles trial. Sleep 37:299-308
Vitiello, Michael V; McCurry, Susan M; Shortreed, Susan M et al. (2013) Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial. J Am Geriatr Soc 61:947-56
Parthasarathy, Sairam; Vitiello, Michael V (2012) 2011 NIH Sleep Disorders Research Plan: a rising tide that lifts all boats. J Clin Sleep Med 8:7-8

Showing the most recent 10 out of 14 publications