Knee OA, a leading cause of pain and disability in older adults, occurs when flexible tissue at the ends of bones wears down. Although it can’t be cured, physical therapy or anti-inflammatory medications are often prescribed to relieve pain and improve mobility.
More than 70% of people with knee OA also suffer from sleep disturbances, researchers note in the journal Pain, online July 31.1
For the current study, researchers randomly assigned 100 people with both insomnia and knee osteoarthritis to receive eight sessions of either cognitive behavioral therapy for insomnia (CBT-I), designed to shift thinking about sleep and bad habits that contribute to insomnia, or behavior desensitization therapy designed to diminish emotional and physical responses to arousing thoughts and behaviors related to sleep.”
Researchers assessed participants’ perceptions of pain before treatment and again three and six months after the interventions finished.
The study team expected the CBT-I to achieve a greater reduction in what’s known as pain catastrophizing, or feeling exaggerated levels of pain that are amplified by being emotionally upset about the pain. Instead, they found similar reductions in negative perceptions of pain with both the cognitive behavioral therapy and behavior desensitization.
“Sleep is really important and when it is compromised like in insomnia it can increase the risk for many negative health outcomes, including chronic pain, depression, obesity, high blood pressure and more,” says lead study author Sheera Lerman, a behavioral health researcher at Johns Hopkins University School of Medicine in Baltimore.
“The good news is that for most people with insomnia, it can be effectively treated without using medication,” Lerman says.
Regardless of what intervention they received, participants experienced fewer negative feelings about both daytime and nighttime pain by the end of treatment, and this persisted three and six months afterwards.
People who had greater reductions in nighttime awakenings early in the study also had a larger decline in negative feelings about pain than people who didn’t experience this type of sleep improvement early on.
The results suggest that even brief interventions focused on sleep improvement may make a big dent in negative feelings people have about their pain, the authors conclude.
One limitation of the study is that people started out with relatively low levels of pain catastrophizing, and there might have been a bigger effect from treatment or a larger difference between therapies if participants had more intense negative feelings about their pain, the researchers note.