Background & Aims

The association between sleep and incident pain is consistent, yet not fully comprehended, particularly when examined at the population level. Research has shown that some sleep-related characteristics are unequal across sociodemographic groups, potentially contributing to variations in pain outcomes. The aim of the present study was to assess if “sleep troubles” and “fatigue symptoms” at baseline were associated with chronic pain incidence at 1-year follow-up, overall, and in subgroups defined by age, sex, and race/ethnicity, in a population-based cohort study of United States (US) adults.

Methods

We used data from the 2019-2020 National Health Interview Survey Longitudinal Cohort (NHIS-LC), a nationally representative of noninstitutionalized US adult civilians. Chronic pain was defined as pain present on most days or every day in the last 3 months. We included adults with complete data and no chronic pain at baseline (n=7,820). For “sleep troubles” and “fatigue symptoms”, we used two questions: how often in the last 2 weeks they had been bothered by “trouble falling or staying asleep, or sleeping too much”, and “feeling tired or having little energy” (not at all [reference], several days, >half the days, or nearly every day). Survey-weighted Poisson regression models determined the effect of sleep troubles and fatigue on chronic pain incidence, adjusted for age, sex, race/ethnicity, family income, and depressive symptoms. Stratified models also included multiplicative interactions with age, sex, and race/ethnicity.

Results

The 1-year population-weighted cumulative incidence of chronic pain was 10.7%. Baseline sleep troubles (several days, >half days, and nearly every day vs. not at all) increased the risk of chronic pain incidence (aRR, 95%CI=1.28, 1.02-1.62, p=0.033; aRR, 95%CI=1.63, 1.16-2.28, p=0.005; aRR, 95%CI=1.61, 1.17-2.22, p=0.033, respectively). Baseline fatigue (several days, >half the days, and nearly every day vs. not at all) increased the risk of chronic pain incidence (aRR, 95%CI=1.44, 1.19-1.74, p<0.001; aRR, 95%CI=1.71, 1.22-2.40, p=0.002; aRR, 95%CI=1.89, 1.32-2.69, p<0.001). The estimated effect of sleep troubles on chronic pain varied by race/ethnicity (joint Wald tests, p<0.001), especially among non-Hispanic (NH)-Asian, NH-Black/African American, and NH-White adults (vs. Hispanic, NH-American Indian/Alaska Native, NH-other race/multiracial). Stratified models for sleep troubles and fatigue did not show evidence of heterogeneity by age (p=0.33, p=0.87) and sex (p=0.26, p=0.32).

Conclusions

This study reveals a significant effect of sleep troubles and fatigue symptoms on 1-year chronic pain incidence across most sociodemographic groups. These results underscore the importance of addressing sleep-related issues in the prevention of chronic pain and enhancing our understanding of the complex interplay between sleep, fatigue, and chronic pain at the population level. Further studies with a focus on racial/ethnically minoritized groups are needed to identify risk and protective factors that may be specific to those populations.

References

1. Nahin RL, Feinberg T, Kapos FP, Terman GW. Estimated Rates of Incident and Persistent Chronic Pain Among US Adults, 2019-2020. JAMA Netw Open. 2023;6(5):e2313563.
2. Afolalu EF, Ramlee F, Tang NKY. Effects of sleep changes on pain-related health outcomes in the general population: A systematic review of longitudinal studies with exploratory meta-analysis. Sleep medicine reviews. 2018;39:82-97.
3. Van de Langenberg SCN, Kocevska D, Luik AI. The multidimensionality of sleep in population-based samples: a narrative review. Journal of sleep research. 2022;31(4):e13608.

Presenting Author

Barbara Fonseca Alonso

Poster Authors

Barbara Fonseca Alonso

MSc

Private practice

Lead Author

E-mail

Alberto Herrero Babiloni

McGill University

Lead Author

E-mail

Marc O Martel

PhD

McGill University

Lead Author

E-mail

Gilles J. Lavigne

DMD

University of Monteal

Lead Author

E-mail

Kenneth A. Taylor

DPT

Komodo Health, San Francisco

Lead Author

E-mail

Adam Goode

DPT

Duke University

Lead Author

E-mail

Flavia Penteado Kapos

Duke University

Lead Author

E-mail

Topics

  • Lifestyle Issues: Sleep/Diet/Exercise/Social Interactions