Joanne Dudeney1, See Wan Tham1, Emma Fisher1, Tonya M. Palermo1
1) United States
Background and aims: Although numerous studies indicate that youth with chronic pain report poor sleep quality, the mechanisms that account for the relationship between pain and sleep are not well understood. Sustained arousal (anxiety, hypervigilance) has been implicated in both poor sleep and in increased pain sensitivity in adults and may play a similar role in youth. Thus, we tested whether increased anxiety symptomatology mediated the relationship between pain intensity and sleep quality in adolescents.
Methods: Fifty adolescents were recruited into the study. Nineteen adolescents had chronic pain (M = 15.4 years, SD = 1.9, 16 females) and were recruited from a pain clinic, and 31 adolescents were healthy community controls (M = 14 years, SD = 1.5, 18 females). Youth completed self-report measures of sleep quality (total score; Adolescent Sleep Wake Scale), pain intensity (11 point NRS), and general anxiety symptomatology (total anxiety score; Revised Child Anxiety and Depression Scale). A mediation model evaluated the indirect effect of anxiety symptoms on the relationship between pain intensity and sleep quality using bootstrapping with bias-corrected 95% confidence intervals.
Results: As expected, adolescents with chronic pain reported significantly higher levels of anxiety symptoms (t(48) = -2.94, p < 0.01), and significantly poorer sleep quality (t(48) = 4.018, p < 0.01) than adolescents without chronic pain. Higher pain intensity was significantly associated with poorer overall sleep quality (more difficulties going to bed, falling asleep, maintaining sleep, and reinitiating sleep). Increased anxiety symptomatology partially mediated this association.
Conclusion: These results indicate that heightened anxiety symptoms may operate as a pathway by which pain intensity and sleep quality are related in adolescents. Further work is needed to understand the expression of heightened arousal in youth with chronic pain to inform interventions targeting both sleep and anxiety symptoms within psychosocial treatments for youth with chronic pain.
