Cognitive-Behavioral Treatment for Comorbid Insomnia and Osteoarthritis Pain in Primary Care: The Lifestyles Randomized Controlled Trial


  • Trial Registration: Identifier: NCT01142349

Address correspondence to Michael V. Vitiello, Psychiatry, Box 356560, University of Washington, Seattle, WA 98195. E-mail:



To assess whether older persons with osteoarthritis (OA) pain and insomnia receiving cognitive–behavioral therapy for pain and insomnia (CBT-PI), a cognitive–behavioral pain coping skills intervention (CBT-P), and an education-only control (EOC) differed in sleep and pain outcomes.


Double-blind, cluster-randomized controlled trial with 9-month follow-up.


Group Health and University of Washington, 2009 to 2011.


Three hundred sixty-seven older adults with OA pain and insomnia.


Six weekly group sessions of CBT-PI, CBT-P, or EOC delivered in participants' primary care clinics.


Primary outcomes were insomnia severity and pain severity. Secondary outcomes were actigraphically measured sleep efficiency and arthritis symptoms.


CBT-PI reduced insomnia severity (score range 0–28) more than EOC (adjusted mean difference = −1.89, 95% confidence interval = −2.83 to −0.96; P < .001) and CBT-P (adjusted mean difference = −2.03, 95% CI = −3.01 to −1.04; P < .001) and improved sleep efficiency (score range 0–100) more than EOC (adjusted mean difference = 2.64, 95% CI = 0.44–4.84; P = .02). CBT-P did not improve insomnia severity more than EOC, but improved sleep efficiency (adjusted mean difference = 2.91, 95% CI = 0.85–4.97; P = .006). Pain severity and arthritis symptoms did not differ between the three arms. A planned analysis in participants with severe baseline pain revealed similar results.


Over 9 months, CBT of insomnia was effective for older adults with OA pain and insomnia. The addition of CBT for insomnia to CBT for pain alone improved outcomes.