0377 ACTIVITY MEASURES POST CBT-I FOR CHRONIC PAIN

Abstract

Introduction: CBT-I has been shown to improve both sleep and pain in chronic pain patients. The mechanisms by which CBT-I improves pain are poorly understood. While studies have shown that increase in physical activity is associated with positive outcomes, the impact of CBT-I on activity has been largely unexplored. In the present analysis, the association between improved pain and diurnal activity was assessed. Method(s): 15 patients (Mean Age=42.9 +/- 10.4; f=12) with chronic pain (non-cancer neck or back pain) who received 8-session CBTI were evaluated by 7-day actigraphy at baseline and post-treatment (only 10 subjects completed actigraphy at both time-points), and completed the Multidimensional Pain Inventory (MPI) for a pain severity score (MPISeverity) at both time-points (all 15 participants completed both MPI assessments). Activity was averaged per-hour using minute-by-minute activity count epochs. Mixed models were utilized to allow for actigraphic missing data and to evaluate the relationship between pain improvement (Responders vs. Non-Responders), phase (baseline vs post-CBTI), and diurnal time (24-hr day) with activity counts per hour. Treatment response was determined based on improvement on MPISeverity>= 30% from baseline. Additionally, exploratory paired-sample t-tests were utilized to evaluate time-of-day of improved activity. Result(s): Based on the MPI-Severity score, there were 8 Responders and 7 Non-Responders. There were no significant differences in activity at baseline. Mixed models revealed a significant phase*group interaction (p=0.003) with significant main effects for phase (p=0.003) and time of day (p<0.001). While there was no, phase*group*time-of-day interaction, paired-sample t-tests revealed that Responders significantly increased activity in the morning (6-9AM) while no significant activity increase is noted for Non-Responders. Conclusion(s): These pilot findings suggest that CBTI improvements in pain severity are associated with diurnal activity increase. Chronic pain patients who achieved clinically meaningful pain reduction tended to have increased activity during the day compared to Non-Responders. The change was more notable with the morning activity. The results suggest the potentially greater role of improving morning activities for pain management. Future studies utilizing larger sample sizes are necessary.