Background & Aims
Approximately one thirds of the world’s population is living with some form of chronic pain (CP), leading to significant socio-economic losses and diminished well-being and quality of living. There is a general consensus that people with chronic pain should be encouraged to remain physically active for pain management and longer-term health benefits. However, the consensus is largely based on evidence for supervised group exercise in specific pain patient subgroup. The direct and indirect effects of day-to-day physical activity (PA) on subsequent pain experience are less understood, and their ecological validity in people living with different forms of CP less established. Using an Experience Sampling Method (ESM), this study aimed to elucidate the day-to-day link between PA and pain experience the next day. As regular PA promotes better sleep, we also examined whether the PA-pain association is partially mediated by nighttime sleep.
Methods
195 subjects with CP wore an actigraph on their non-dominant wrist, day and night, for 7 days in their natural sleep-wake environment. They completed a sleep diary each morning to measure total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), sleep quality (SQ), and rated pain intensity 3 times per day (09:00 – 16:00, spaced by 2.5 hours). Using 24-hour actigraphy data averaged across 7 days, the non-parametric feature M10 (average PA intensity during the most active 10 hours) was chosen as the measure of daytime PA. Actigraphy also generated the same nighttime sleep parameters as the sleep diary, except SQ. Pain experience was indexed by the average of the 3 pain intensity ratings collected the next day. Correlation and mediational analyses were performed to explore (1) whether daytime PA is associated with next-day pain, and (2) whether this association is mediated by actigraphy-derived and self-reported nighttime sleep parameters.
Results
Bivariate correlational analyses indicated that only self-reported SOL, WASO, SE, and SQ are associated with 7-day average M10 and daily average pain ratings. A simple linear regression showed that M10 was associated with pain experience (? = -.30, p < .001). Four separate mediation analyses revealed that only the M10 ? self-reported SQ ? pain experience indirect pathway was statistically significant after adjusting the corresponding p-values of all these four indirect pathways with false discovery rate and Bonferroni correction (? = .12, p < .004). In particular, M10 was associated with better self-reported SQ (? = .27, p < .001), and self-reported SQ was associated with pain experience (? = -.45, p < .001). The direct effect of M10 on pain experience was still significant after considering the M10 ? self-reported SQ ? pain experience indirect pathway (? = -.18, p < .004), supporting a partial mediation model.
Conclusions
Findings from the present study showed that higher daytime PA was associated with less pain experience across the 7-day ESM. Meanwhile, self-reported SQ, rather than other objectively measured nighttime sleep parameters, was identified as a significant partial mediator of the relationship between PA and pain experience. Specifically, higher PA was associated with higher self-reported SQ, which in turn was associated with less pain experience. However, while the present study adopted ESM for data collection, its statistical analyses were cross-sectional in nature, implying that caution shall be taken when drawing cause-effect inferences. Therefore, subsequent studies might address this methodological limitation by applying mixed linear modelling or longitudinal network analysis to investigate the temporality of how PA, sleep, and pain level on the previous day affect those variables on the subsequent day.
References
Bilterys, T., Nijs, J., & Tang, N. (2024). Pain and Sleep: Underlying mechanisms of the sleep-pain relationship. In Advances in the Psychobiology of Sleep and Circadian Rhythms (pp. 141-157). Routledge.
Hodges, P. W., & Smeets, R. J. (2015). Interaction between pain, movement, and physical activity: short-term benefits, long-term consequences, and targets for treatment. The Clinical journal of pain, 31(2), 97-107.
Macchia, L., Delaney, L., & Daly, M. (2024). Global pain levels before and during the COVID-19 pandemic. Economics & Human Biology, 52, 101337.
Selvanathan, J., Tang, N. K., Peng, P. W., & Chung, F. (2022). Sleep and pain: relationship, mechanisms, and managing sleep disturbance in the chronic pain population. International Anesthesiology Clinics, 60(2), 27-34.
Tang, N. K., Banks, P. D., & Sanborn, A. N. (2023). Judgement of sleep quality of the previous night changes as the day unfolds: A prospective experience sampling study. Journal of Sleep Research, 32(3), e13764.
Presenting Author
Peter To
Poster Authors
Topics
- Lifestyle Issues: Sleep/Diet/Exercise/Social Interactions