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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Article info
Publication history
Published online: September 26, 2017
Accepted:
September 5,
2017
Received in revised form:
August 10,
2017
Received:
June 25,
2017
Footnotes
This research was supported by Hearst Grant awarded to Dr. Noel from the Center for Child Health Behavior and Development, Seattle Children's Research Institute as well as a National Institutes of Health grant (2K24HD060068) awarded to Dr. Palermo. At the time that this research was conducted, Dr. Noel was a trainee member of Pain in Child Health, a Strategic Training Initiative of the Canadian Institutes of Health Research. She was also supported by a Canadian Institutes of Health Research Post-Doctoral Award. During the time that this report was written, Dr. Noel was supported by the Alberta Children's Hospital Research Institute (Vi Riddell Pediatric Pain Initiative). This research was also supported by a Career Development Award from the Eunice Kennedy Shriver National Institute on Child Health and Human Development (K23 HD071946, A.L.H.).
The authors have no conflicts of interest to declare.
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© 2017 by the American Pain Society
