Secondary Logo

Institutional members access full text with Ovid®

Intraindividual Variability in Daily Sleep and Pain Ratings Among Chronic Pain Patients: Bidirectional Association and the Role of Negative Mood

O'Brien, Erin M. PhD*; Waxenberg, Lori B. PhD; Atchison, James W. DO; Gremillion, Henry A. DDS§; Staud, Roland M. MD; McCrae, Christina S. PhD; Robinson, Michael E. PhD

The Clinical Journal of Pain: June 2011 - Volume 27 - Issue 5 - p 425–433
doi: 10.1097/AJP.0b013e318208c8e4
Original Articles

Objectives Sleep disturbance is a common problem among chronic pain patients. Cross-sectional data from clinical populations and experimental studies have shown an association between sleep disturbance and pain. However, there has been little prospective research into the relationship between daily variability between sleep and pain among chronic pain patients.

Methods Twenty-two women with chronic pain (back pain, facial pain, fibromyalgia) completed a sleep diary and wore an actigraph for a 2-week period. Self-report measures of pain, mood, and sleep were also completed at baseline. Hierarchical linear modeling (HLM) was used to examine intraindividual variability in sleep and pain ratings among these women. The impact of mood and baseline pain ratings was also examined as potential moderators.

Results Hierarchical linear modeling analyses supported a bidirectional relationship between sleep and pain, such that a night of poor sleep was followed by increased pain ratings the following day and a day of increased pain was followed by a night of poor sleep. Depression scores further influenced these relationships.

Discussion Prospective examination supported a bidirectional relationship between sleep and pain among a group of women with chronic pain. Depressive symptoms had a moderating impact on these relationships. These findings suggest that addressing sleep is important in the treatment of individuals with chronic pain.

*Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI

Department of Clinical and Health Psychology, University of Florida

College of Medicine, University of Florida, Gainesville, FL

§School of Dentistry, Louisiana State University, New Orleans, LA

Supported by the provision of actigraphy equipment from MiniMitter-Respironics, Inc. Bend, OR.

Reprints: Erin M. O'Brien, PhD, Department of Outpatient Psychiatry, Rhode Island Hospital, 235 Plain Street, Bayside Suite 501, Providence, RI 02905 (e-mail:

Received July 12, 2010

Accepted November 11, 2010

© 2011 Lippincott Williams & Wilkins, Inc.