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Sleep Mediates the Association Between PTSD Symptoms and Chronic Pain in Youth

Published:September 26, 2017DOI:https://doi.org/10.1016/j.jpain.2017.09.002

      Highlights

      • Sleep quality partially mediated the association between post-traumatic stress symptoms (PTSS) and pain characteristics among a cohort of youth with chronic pain.
      • Higher levels of PTSS was associated with higher levels of pain intensity as well as pain interference and these PTSS-pain relationships were partially explained by poor sleep quality.
      • Sleep is a modifiable mechanism that could be targeted in interventions, which might alter a trajectory of pain and comorbid mental health problems from persisting into adulthood.

      Abstract

      Symptoms of post-traumatic stress disorder (PTSS) and chronic pain have been shown to co-occur at high rates in adolescents and this co-occurrence is linked to worse pain and quality of life. Sleep disturbance has been posited as a mechanism underlying this co-occurrence in conceptual models of mutual maintenance. This study examined the mediating role of sleep in the relationship between PTSS and pain in youth (aged 10–17 years) with chronic pain. Ninety-seven participants completed measures of PTSS, pain (intensity and interference), anxiety symptoms, and sleep quality, in addition to demographic characteristics. Mediation models were conducted. Findings revealed that, over and above the influence of associated demographic characteristics (age, race) and anxiety symptoms, sleep quality partially mediated the relationships between PTSS and pain intensity and interference for youth with chronic pain. Specifically, higher levels of PTSS was linked to higher levels of pain intensity and pain interference, and these relationships were partially explained by poor sleep quality. Findings highlight the potential mechanistic role of sleep in explaining the co-occurrence of chronic pain and PTSS and suggest sleep might be an important target in future interventions.

      Perspective

      Consistent with the pediatric model of mutual maintenance in PTSS and chronic pain, poor sleep quality was found to underlie this co-occurrence in youth.

      Key words

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