Background & Aims

There is an increasing interest in determining the factors underlying the co-occurrence and maintenance of pain and sleep disturbance in children and adolescents with chronic pain (Arnison et al., 2022; Pavlova et al., 2017; Solé et al., 2022). Fatigue has been suggested as one such factor (Yoon et al., 2019). However, the findings supporting this hypothesis come from cross-sectional studies, which makes it difficult to draw causal conclusions.
This study used data from a longitudinal epidemiology study of children and adolescents with chronic pain (EPIDOL) to examine: (1) the co-occurrence of sleep disturbance and pain at initial assessment (Time 1) and 12 months later (Time 2); (2) the bidirectional association between sleep disturbance and pain over time; and (3) the mediating role of fatigue in the temporal association between sleep disturbance, pain intensity, and pain interference over time.

Methods

Longitudinal data from 355 adolescents (67% female) with chronic pain aged 8-18 years were extracted from EPIDOL. Participants provided sociodemographic information and completed surveys with questions assessing pain-related characteristics, sleep disturbance, and fatigue at both time points. Partial cross-lagged panel structural equation analyses were conducted.

Results

Higher levels of pain interference at Time 1 predicted subsequent higher levels of pain interference (? = .36, P < .001) and sleep disturbance at Time 2 (? = .15, P < .01). Higher levels of sleep disturbance at Time 1 predicted subsequent sleep disturbance (? = .24, P < .001) but not pain interference (? = -.03, P > .05) at Time 2. Higher levels of fatigue at Time 1 predicted subsequent pain interference (? = .14, P < .05) and sleep disturbance (? = .17, P < .01) at Time 2. Furthermore, fatigue mediated the associations between sleep disturbance at Time 1 and sleep disturbance at Time 2 (B = 0.02, P < .05), pain interference at Time 1 and pain interference at Time 2 (B = 0.08, P < .05), and pain interference at Time 1 and sleep disturbance at Time 2 (B = 0.13, P < .01).

Conclusions

The study findings contribute to our understanding of the complex relationship between sleep disturbance and pain in children and adolescents with chronic pain. The findings support a conceptual model suggesting that psychological and physiological factors influence the interplay between pain and sleep disturbance in this population.

References

Arnison, T., Schrooten, M. G. S., Hesser, H., Jansson-Fröjmark, M., & Persson, J. (2022). Longitudinal, bidirectional relationships of insomnia symptoms and musculoskeletal pain across adolescence: the mediating role of mood. PAIN, 163(2). https://journals.lww.com/pain/Fulltext/2022/02000/Longitudinal,_bidirectional_relationships_of.6.aspx

Pavlova, M., Ference, J., Hancock, M., & Noel, M. (2017). Disentangling the Sleep-Pain Relationship in Pediatric Chronic Pain: The Mediating Role of Internalizing Mental Health Symptoms. Pain Research and Management, 2017. https://doi.org/10.1155/2017/1586921

Solé, E., Sharma, S., Ferreira-Valente, A., Pathak, A., Sánchez-Rodríguez, E., Jensen, M. P., & Miró, J. (2022). The Associations between Sleep Disturbance, Psychological Dysfunction, Pain Intensity, and Pain Interference in Children with Chronic Pain. Pain Medicine (United States), 23(6), 1106–1117. https://doi.org/10.1093/pm/pnab333

Yoon, I. A., Sturgeon, J. A., Feinstein, A. B., & Bhandari, R. P. (2019). The role of fatigue in functional outcomes for youth with chronic pain. European Journal of Pain (United Kingdom), 23(8), 1548–1562. https://doi.org/10.1002/ejp.1431

Presenting Author

Josep Roman-Juan

Poster Authors

Josep Roman-Juan

MSc

Universitat Rovira i Virgili. Catalonia, Spain

Lead Author

Guillermo Ceniza-Bordallo

MSc

University Complutense of Madrid. Madrid, Spain.

Lead Author

Elisabet Sánchez-Rodríguez

PhD

Universitat Rovira i Virgili. Catalonia, Spain

Lead Author

Mark P. Jensen

PhD

University of Washington. Seattle, WA, USA

Lead Author

Jordi Miro

Universitat Rovira i Virgili

Lead Author

Topics

  • Epidemiology