Written By: Jennifer Garcia
Treatment with cognitive behavioral therapy (CBT) may help relieve insomnia and pain among patients with knee osteoarthritis (KOA), according to a new double-blind, randomized placebo-controlled clinical trial. The study findings were published online January 26 in Arthritis and Rheumatology.
Researchers led by Michael T. Smith, PhD, from the Johns Hopkins Center for Behavior and Health, Baltimore, Maryland, enrolled 100 patients between September 2008 and April 2013 who had been diagnosed with KOA, as determined by a rheumatologist. Eligible patients had radiographic evidence of KOA, knee pain ratings of 2 or more out of 10, and pain more than 5 days/week for more than 6 months and were receiving a stable dose of nonsteroidal anti-inflammatory drugs, if required. In addition, eligible patients met criteria for insomnia disorder, with “symptom duration > 1 month…> 2 nocturnal awakenings of >15 minutes duration…or self-reported wake after sleep onset time and/or latency to sleep onset >30 minutes.” 
The researchers randomly assigned the patients to receive eight sessions of CBT or behavioral desensitization placebo and evaluated sleep duration and quality using in-home polysomnograms (PSG), patient diaries, actigraphy, and baseline and posttreatment assessments of pain at 3 and 6 months. Pain assessments included a Pain Intensity Index and a sliding visual analog scale, as well as the Western Ontario McMaster Universities Osteoarthritis Scale.
According to diary, PSG, and actigraphy readings, patients in the CBT intervention group experienced a decrease in sleep maintenance insomnia, measured as wake after sleep onset time. Approximately 80% of patients in the CBT group “achieved normative clinical values for diary [wake after sleep onset time] (<30 mins.) compared to [behavioral desensitization] (50%) at posttreatment and 3 months.” These rates were similar (60%) between the groups at 6 months, and the authors posit whether periodic booster sessions or reinforcement of coping skills may be used to address this attenuation of the effects of CBT.