0393 Baseline Pain Severity as a Moderator of the Effect of CBTi on Sleep and Pain Outcomes in Patients with Fibromyalgia
Bibliographic record
Abstract
CBTi improves sleep and pain in patients with chronic pain, but significant pain effects are rarely found in individual trials - possibly due to floor effects as trials rarely screen for baseline pain intensity (bPI). The present study examines whether bPI moderates the effect of CBTi on sleep and pain in adults with FM. Adults (N=64, Mage=53.2, SD=13.7) with FM and chronic insomnia were randomized to 8-week CBT-I or waitlist control. Participants completed the McGill Pain Questionnaire (MPQ) and 14 daily diaries recording PI (0-none, 100-worst), SOL, WASO, TWT, and sleep quality (1-very good, 5-very poor) at baseline, post-treatment, and 6-month follow-up. Multiple regressions determined whether average bPI predicted changes in sleep (SOL, WASO, TWT, sleep quality) and pain (MPQ total score), controlling for age, sleep/pain medication, TST, and depression. bPI moderated the impact of CBTi on SOL (t=2.42, p=.02) and TWT (t=2.02, p=.05). Specifically, moderate (53.32, SOL t=2.43, p=.02; TWT t=3.18, p<.001) and high (71.18, SOL t=3.68, p<.001; TWT t=3.96, p<.001) bPI were associated with improved SOL and TWT at post-treatment relative to baseline, whereas these associations were not observed for low bPI (35.80, SOL p=.96, TWT p=.37). bPI trended toward significance for the MPQ (p=.06) and WASO (p=.11), but did not moderate changes in sleep quality. Baseline to follow-up results were similar. FM patients with moderate to severe pain may be better candidates for CBTi than those with less severe pain. Clinical trial researchers may wish to consider adopting pain severity criteria for determining eligibility for CBT trials. While our findings suggest a score of ~50/100 may identify patients likely to benefit from CBTi, research is needed to determine the best screening cutoff score and to identify better treatment options for chronic pain patients with less severe pain. NIAMS (R01AR055160 and R01AR005160-S1; McCrae, PI). Data collected as part of clinical trial NCT02001077 Sleep and Pain Interventions (SPIN) at the University of Florida (McCrae, PI).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".