Highlights
- •Lagged models were estimated for 665 tertiary care patients with chronic pain.
- •Pain intensity predicts later changes in sleep disturbance.
- •Pain intensity is not associated with future changes in mood symptoms or disability.
- •Symptoms of post-traumatic stress disorder and disability predict future changes in pain intensity.
Abstract
Despite a common assumption that reductions in chronic pain intensity must precede
improvements in other pain-relevant domains, there has been limited empirical inquiry
into the temporal ordering of improvements in chronic pain treatment. Cross-lagged
models using retrospective clinical data examined relationships between average pain
intensity and symptoms of psychological distress, difficulties with sleep initiation
and maintenance, and disability in 666 treatment-seeking patients with chronic pain
who demonstrated improvement in pain intensity (≥1-point reduction on 0-10 numeric
rating scale) over a 1-year span. Results indicated that decreased difficulties with
sleep initiation, depressive and anxious symptoms, and disability predicted later
improvement in pain intensity, whereas greater pain intensity predicted only later
difficulties in sleep initiation and maintenance. A combined lagged model highlighted
fewer baseline symptoms of post-traumatic stress disorder and lower levels of baseline
disability as significant predictors of later improvements in pain. Overall, our results
indicate that reductions in pain intensity may not be the first factors to change
in effective chronic pain management. The current findings should be replicated using
prospective studies utilizing structured approaches to maximize data capture, as well
as uniform interventional approaches to permit greater inferences regarding causal
and temporal aspects of the model.
Perspective
This study demonstrates that pain intensity scores are not robust predictors of psychosocial
outcomes longitudinally. Instead, other factors such as sleep initiation, psychological
distress and disability appear to be important targets for intervention that may promote
effective pain reduction.
Key words
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Article info
Publication history
Published online: October 15, 2020
Accepted:
October 12,
2020
Received:
August 17,
2020
Footnotes
Disclosures: Dr. Sturgeon is a scientific advisory board consultant for TribeRx. Dr. Sullivan reports grants from Pfizer, personal fees from Revon, personal fees from Aetna, personal fees from Chrono Therapeutics, personal fees from State of Maryland, Attorney General, outside the submitted work. The authors have no other conflicts of interest or interests to disclose.
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Copyright
© 2020 by United States Association for the Study of Pain, Inc.
