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Sleep. 2018 Nov 28. doi: 10.1093/sleep/zsy234. [Epub ahead of print]

Cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in adults with comorbid chronic insomnia and fibromyalgia: Clinical outcomes from the SPIN randomized controlled trial.

Author information

Psychiatry, University of Missouri-Columbia One Hospital Drive Columbia, MO, USA.
Clinical and Health Psychology, University of Florida, FL, USA.
Rheumatology and Clinical Immunology, University of Florida Gainesville, FL, USA.
Division of Pulmonary, Critical Care and Sleep Medicine Suite C Gainesville, FL, USA.



To examine the effects of cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in patients with comorbid fibromyalgia and insomnia.


113 patients (Mage=53, SD=10.9) were randomized to eight sessions of CBT-I (n=39), CBT-P (n=37), or a waitlist control (WLC, n=37). Primary [self-reported sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), sleep quality (SQ), pain ratings)] and secondary outcomes [dysfunctional attitudes about sleep (DBAS); actigraphy and polysomnography SOL, WASO, and SE; McGill Pain Questionnaire; Pain Disability Index; depression; anxiety] were examined at post-treatment and 6-months.


Mixed effects analyses revealed both treatments improved self-reported WASO, SE, and SQ relative to control at post-treatment and follow-up, with generally larger effect sizes for CBT-I. DBAS improved in CBT-I only. Pain and mood improvements did not differ by group. Clinical significance analyses revealed the proportion of participants no longer reporting difficulties initiating and maintaining sleep was higher for CBT-I post-treatment and for both treatments at 6-months relative to control. Few participants achieved >50% pain reductions. Proportion achieving pain reductions >30% (~1/3) was higher for both treatments post-treatment and for CBT-I at 6-months relative to control.


CBT-I and CBT-P improved self-reported insomnia symptoms. CBT-I prompted improvements of larger magnitude that were maintained. Neither treatment improved pain or mood. However, both prompted clinically meaningful, immediate pain reductions in one third of patients. Improvements persisted for CBT-I, suggesting CBT-I may provide better long-term pain reduction than CBT-P. Research identifying which patients benefit and mechanisms driving intervention effects is needed.


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