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Pain is a central feature of many medical conditions that occur with increased frequency in elderly individuals; these conditions include arthritis, neuropathies, angina, reflux esophagitis, and peptic ulcer disease (Aldrich 2000). Disruption of sleep is frequently noted in persons with significant pain (Pilowsky et al. 1985). Attempts to ameliorate the condition causing the pain should be the first step. When these attempts fail, treatment for the pain should be instituted. Often, combined behavioral and pharmacological treatment is needed. There is some evidence that, as with depression, pain may have a bidirectional relationship with sleep disturbance. Two studies suggest that the treatment of insomnia leads to improvement in pain. These studies involved the treatment of individuals with fibromyalgia with cognitive-behavioral therapy for insomnia and treatment of individuals with rheumatoid arthritis with the benzodiazepine triazolam (Edinger et al. 2005; Walsh et al. 1996). These data speak to the importance of treating insomnia in those with chronic pain (see "Treatment of Insomnia" later in this chapter).

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