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The COVID-19 pandemic social distancing mandates have increased levels of social isolation, a change which appears to have impacted some chronic pain patients more than others. Previous research suggests that feelings of loneliness and sleep disturbance may importantly modulate pain. In the present study, we examined whether the personality trait of introversion served as a protective factor against worsening pain interference during conditions of social isolation, and whether this was related to differences in sleep disturbance and loneliness. Chronic pain patients in Massachusetts (n=150) completed electronic questionnaires 4-8 weeks after the state-wide social distancing mandate. Validated questionnaires included the Brief Pain Inventory (BPI), Myers-Briggs introversion/extroversion subscale (1-10), UCLA Loneliness and PROMIS Sleep Disturbance short forms. Change scores were calculated by subtracting recalled scores from current scores. Linear regression was used to assess association between factors, and mediation analyses were used to assess the degree to which other factors mediated the relationship between introversion and change in pain interference. Introversion scores were inversely related to increased pain interference since social distancing (Rho=-0.194, p=0.017), such that patients with higher introversion scores showed little to no change in pain interference, compared to more extroverted patients. Higher introversion was also associated with lower increases in sleep disturbance (Rho=-0.163, p=0.046) and loneliness (Rho=-0.279, p=0.001) since social distancing. Multiple simple mediation analyses revealed that the relationship between introversion and change in pain interference was partially mediated by differential changes in sleep disturbance and loneliness. Chronic pain patients experience varying degrees of worsening of pain interference with social distancing, which may be partially explained by their degree of introversion/extroversion. In particular, more introverted patients appeared to be partially protected, experiencing less of an increase in loneliness and sleep disturbance and, in turn, less of an increase in pain interference. 5R35GM128691-02.
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