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Perceived Pain Following Hypnotic Deprescribing in Older Adults.

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Title: Perceived Pain Following Hypnotic Deprescribing in Older Adults.
Authors: Hurtado, Jennifer G., Erickson, Alexander J., Mitchell, Michael N., Martin, Jennifer L., Alessi, Cathy A., Dzierzewski, Joseph M., Ghadimi, Sara, Der‐Mcleod, Erin, Perdomo, Claudia, Naeem, Saadia, Moore, Alison A., Badr, M. Safwan, Zeidler, Michelle, Fung, Constance H.
Source: Journal of the American Geriatrics Society. Mar2026, Vol. 74 Issue 3, p669-675. 7p.
Subjects: Benzodiazepines, Research funding, Insomnia, Deprescribing, Tranquilizing drugs, Pain in old age
Abstract: Background: Older adults with chronic insomnia often use benzodiazepine receptor agonists (BZRAs) despite known associated risks and non‐pharmacological alternatives such as cognitive behavioral therapy for insomnia (CBTI). CBTI reduces insomnia severity and could potentially improve other outcomes such as the impact of pain on daily activities, even when BZRAs are deprescribed. Yet concerns that deprescribing may worsen pain (which is often comorbid with insomnia) can be a barrier to engagement in BZRA deprescribing. This study examined changes in pain outcomes associated with deprescribing BZRAs in the context of concurrent CBTI. Methods: Secondary data analysis was conducted using data from a randomized clinical trial that successfully decreased BZRA use in older adults. Participants (n = 188), who were largely older (68% ≥ 65 years, 55 ≤ range ≤ 91) and male (65%), completed CBTI concurrently with a deprescribing intervention (blinded encapsulated BZRA taper or open pill cutter taper). Participants completed the Brief Pain Inventory (BPI) at baseline, one week posttreatment (1 WK), and at a six‐month (6 M) follow‐up. Analyses included mixed effects models among all participants and a subset aged 65+ as well as comparison of model results to minimal clinically important difference (MCID) thresholds. Results: Mixed effects models demonstrated that pain severity did not change significantly over time, broadly or in participants aged ≥ 65 years. Significant reductions in pain interference in day‐to‐day living at 1 WK were observed broadly, although these reductions did not meet the MCID threshold and were no longer significant at 6 M follow‐up. Conclusions: Combined BZRA deprescribing and CBTI did not meaningfully worsen pain in older adults. These results highlight the opportunity for using a combination of CBTI and deprescribing methods in patients with insomnia and comorbid pain, as well as a need for additional interventions to specifically address pain in older adults with chronic insomnia. Summary: Key points○Older patients and clinicians may be hesitant to deprescribe benzodiazepine receptor agonists medications due to concerns about worsened pain from withdrawal or poor sleep related to insomnia rebound.○A combined benzodiazepine receptor agonists deprescribing and cognitive behavioral therapy for insomnia approach, while not significantly improving pain in a clinically meaningful way, appears to improve sleep without causing any worsening of pain.Why does this paper matter?○Comorbid insomnia disorder and pain conditions are highly prevalent, especially in older adult populations. This study shows that benzodiazepine receptor agonists deprescribing in combination with cognitive behavioral therapy for insomnia do not increase pain and may yield short‐term modest benefits to daily living with pain. Results of this study can help further open the door to deprescribing and sleep interventions in older adult populations. [ABSTRACT FROM AUTHOR]
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Database: Psychology and Behavioral Sciences Collection
Description
Abstract:Background: Older adults with chronic insomnia often use benzodiazepine receptor agonists (BZRAs) despite known associated risks and non‐pharmacological alternatives such as cognitive behavioral therapy for insomnia (CBTI). CBTI reduces insomnia severity and could potentially improve other outcomes such as the impact of pain on daily activities, even when BZRAs are deprescribed. Yet concerns that deprescribing may worsen pain (which is often comorbid with insomnia) can be a barrier to engagement in BZRA deprescribing. This study examined changes in pain outcomes associated with deprescribing BZRAs in the context of concurrent CBTI. Methods: Secondary data analysis was conducted using data from a randomized clinical trial that successfully decreased BZRA use in older adults. Participants (n = 188), who were largely older (68% ≥ 65 years, 55 ≤ range ≤ 91) and male (65%), completed CBTI concurrently with a deprescribing intervention (blinded encapsulated BZRA taper or open pill cutter taper). Participants completed the Brief Pain Inventory (BPI) at baseline, one week posttreatment (1 WK), and at a six‐month (6 M) follow‐up. Analyses included mixed effects models among all participants and a subset aged 65+ as well as comparison of model results to minimal clinically important difference (MCID) thresholds. Results: Mixed effects models demonstrated that pain severity did not change significantly over time, broadly or in participants aged ≥ 65 years. Significant reductions in pain interference in day‐to‐day living at 1 WK were observed broadly, although these reductions did not meet the MCID threshold and were no longer significant at 6 M follow‐up. Conclusions: Combined BZRA deprescribing and CBTI did not meaningfully worsen pain in older adults. These results highlight the opportunity for using a combination of CBTI and deprescribing methods in patients with insomnia and comorbid pain, as well as a need for additional interventions to specifically address pain in older adults with chronic insomnia. Summary: Key points○Older patients and clinicians may be hesitant to deprescribe benzodiazepine receptor agonists medications due to concerns about worsened pain from withdrawal or poor sleep related to insomnia rebound.○A combined benzodiazepine receptor agonists deprescribing and cognitive behavioral therapy for insomnia approach, while not significantly improving pain in a clinically meaningful way, appears to improve sleep without causing any worsening of pain.Why does this paper matter?○Comorbid insomnia disorder and pain conditions are highly prevalent, especially in older adult populations. This study shows that benzodiazepine receptor agonists deprescribing in combination with cognitive behavioral therapy for insomnia do not increase pain and may yield short‐term modest benefits to daily living with pain. Results of this study can help further open the door to deprescribing and sleep interventions in older adult populations. [ABSTRACT FROM AUTHOR]
ISSN:00028614
DOI:10.1111/jgs.70273