Abstract
This study aimed to 1) examine trajectories of insomnia symptoms in adolescents with
chronic pain compared to their healthy peers; 2) evaluate psychological and behavioral
risk factors for longitudinal insomnia symptoms; and 3) evaluate insomnia as a predictor
of quality of life, activity limitations, and healthcare utilization over 12 months.
Participants included 61 adolescents with chronic pain and 60 youths without chronic
pain (12–18 years; 72% female). Questionnaires were completed at enrollment, 6 months,
and 12 months and assessed pain intensity, insomnia symptoms, sleep hygiene, presleep
arousal, depression, pubertal status, activity limitations, quality of life, and healthcare
utilization. Insomnia symptoms persisted for both groups and remained higher at all
time points for youths with chronic pain. Generalized estimating equations modeling
identified 3 risk factors for longitudinal insomnia symptoms: having chronic pain,
poorer sleep hygiene, and higher depressive symptoms. Insomnia symptoms also predicted
poorer quality of life over time and were associated with more frequent healthcare
utilization. Findings suggest that sleep problems are persistent and associated with
negative impact for youths with chronic pain. Treatment of insomnia symptoms in youths
with chronic pain may lead to improvements in quality of life and reductions in healthcare
costs.
Perspective
Insomnia symptoms are persistent over a 12-month period and are associated with negative
impact for youths with chronic pain. These findings suggest that treatment of insomnia
symptoms in youths with chronic pain may lead to improvements in quality of life and
reductions in healthcare costs.
Key words
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References
- Validation of the insomnia severity index as an outcome measure for insomnia research.Sleep Med. 2001; 2: 297-307
- Sleep and its relationship to pain, dysfunction, and disease activity in juvenile rheumatoid arthritis.J Rheumatol. 2002; 29: 169-173
- Prevalence of sleep disorders in childhood and adolescence with headache: A case-control study.Cephalalgia. 1997; 17: 492-498
- Sleep hygiene and migraine in children and adolescents.Cephalalgia. 1999; 19: 57-59
- Sleep and fatigue and the relationship to pain, disease activity and quality of life in juvenile idiopathic arthritis and juvenile dermatomyositis.Rheumatology (Oxford). 2011; 50: 2051-2060
- Patterns of sleep and sleepiness in adolescents.Pediatrician. 1990; 17: 5-12
- Assessment of symptoms of dsm-iv anxiety and depression in children: A revised child anxiety and depression scale.Behav ResTher. 2000; 38: 835-855
- Evidence-based assessment of pediatric pain.J Pediatr Psychol. 2008; 33: 939-955
- Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia.J Pediatr Psychol. 2006; 31: 714-723
- Presleep arousal and sleep disturbances in children.Sleep. 2008; 31: 1745-1747
- Insomnia and quality of life in children referred for limb pain.J Rheumatol. 2007; 34: 2486-2490
- Brief report: Daytime and nighttime sleep patterns in adolescents with and without chronic pain.Health Psychol. 2011; (Advance online publication doi:)
- The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents.Pediatrics. 2005; 115: 257-265
- Temporal daily associations between pain and sleep in adolescents with chronic pain versus healthy adolescents.Pain. 2010; 151: 220-225
- Sleep patterns in female adolescents with chronic musculoskeletal pain.Behav Sleep Med. 2005; 3: 193-208
- Migraine headaches and sleep disturbances in children.Headache. 2003; 43: 362-368
- Brief report: Pain and sleep-wake disturbances in adolescents with depressive disorders.J Clin Child Adolesc Psychol. 2012; 41: 482-490
- The phenomenology of the pre-sleep state: The development of the pre-sleep arousal scale.Behav ResTher. 1985; 23: 263-271
- Sleep quality and efficiency in adolescents with chronic pain: Relationship with activity limitations and health-related quality of life.Behav Sleep Med. 2008; 6: 234-250
- Validation of a self-report questionnaire version of the child activity limitations interview (cali): The cali-21.Pain. 2008; 139: 644-652
- Objective and subjective assessment of sleep in adolescents with chronic pain compared to healthy adolescents.Clin J Pain. 2007; 23: 812-820
- Behavioral and psychosocial factors associated with insomnia in adolescents with chronic pain.Pain. 2011; 152: 89-94
- Cognitive Behavioral Treatment of Insomnia.Springer, New York2005
- A self-report measure of pubertal status: Reliability, validity, and initial norms.J Youth Adolesc. 1988; 17: 117-133
- The ces-d scale: A self-report depression measure for research in the general population.Appl Psyc Meas. 1977; 1: 385-401
- Pain among children and adolescents: Restrictions in daily living and triggering factors.Pediatrics. 2005; 115: 152-162
Smith MD, McGhanWF: Insomnia: Costs to lose sleep over. Bus Health 15:57-58, 60, 1997
- A behavioral perspective on insomnia treatment.Psychiatr Clin North Am. 1987; 10: 541-553
Stoller MK: Economic effects of insomnia. Clin Ther 16:873-987; discussion 854, 1994
- Patterns and predictors of health service utilization in adolescents with pain: Comparison between a community and a clinical pain sample.J Pain. 2011; 12: 747-755
- Brief report: Sleep in children with sickle cell disease: An analysis of daily diaries utilizing multilevel models.J Pediatr Psychol. 2007; 32: 857-861
- The pedsql multidimensional fatigue scale in pediatric rheumatology: Reliability and validity.J Rheumatol. 2004; 31: 2494-2500
- Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis.J Clin Sleep Mede. 2009; 5: 355-362
- Numerical rating scale for self-report of pain intensity in children and adolescents: Recent progress and further questions.Eur J Pain. 2009; 13: 1005-1007
Article info
Publication history
Published online: October 01, 2012
Accepted:
August 10,
2012
Received in revised form:
July 24,
2012
Received:
April 11,
2012
Footnotes
The authors have no financial or other relationship that might lead to a conflict of interest. This study was supported by the National Institute of Child Health and Human Development grant number R01HD053431 awarded to the first author (T.M.P.).
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
