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Perceived Pain Following Hypnotic Deprescribing in Older Adults
Jennifer G Hurtado1,2, Alexander J Erickson2,3, Michael N Mitchell2
1Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA.
Journal of the American Geriatrics Society
|January 10, 2026
Summary
Deprescribing benzodiazepine receptor agonists (BZRAs) alongside cognitive behavioral therapy for insomnia (CBTI) did not worsen pain in older adults. This combined approach offers a safe option for managing insomnia and comorbid pain.
Area of Science:
- Gerontology
- Sleep Medicine
- Pain Management
Background:
- Older adults with chronic insomnia frequently use benzodiazepine receptor agonists (BZRAs), despite associated risks and available non-pharmacological alternatives like cognitive behavioral therapy for insomnia (CBTI).
- CBTI can reduce insomnia severity and potentially improve pain outcomes, even during BZRA deprescribing.
- Fear of pain exacerbation during BZRA deprescribing can deter engagement, particularly when pain is comorbid with insomnia.
Purpose of the Study:
- To investigate changes in pain outcomes among older adults undergoing concurrent BZRA deprescribing and CBTI.
- To assess the impact of discontinuing BZRAs on pain severity and interference in daily activities.
Main Methods:
- Secondary data analysis from a randomized clinical trial involving 188 older adults (68% aged 65+).
- Participants received CBTI concurrently with a BZRA deprescribing intervention (tapering).
- Pain was assessed using the Brief Pain Inventory (BPI) at baseline, 1 week, and 6 months post-treatment, analyzed with mixed-effects models.
Main Results:
- No significant changes in overall pain severity were observed over time in the general cohort or in those aged 65 and older.
- Significant short-term reductions in pain interference with daily living were noted at 1 week post-treatment, but these did not reach minimal clinically important difference (MCID) thresholds and were not sustained at 6 months.
- The combined intervention of BZRA deprescribing and CBTI did not lead to a meaningful worsening of pain outcomes.
Conclusions:
- Combined BZRA deprescribing and CBTI is a viable strategy for older adults with insomnia and comorbid pain, as it does not appear to exacerbate pain.
- These findings suggest that this combined approach can be safely implemented, addressing concerns about pain worsening during BZRA discontinuation.
- Further research is needed to identify interventions specifically targeting pain management in older adults with chronic insomnia who are undergoing deprescribing.
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