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Associations Between Sleep Disturbance and Chronic Pain Intensity and Function

A Test of Direct and Indirect Pathways

Burgess, Helen J., PhD*; Burns, John W., PhD; Buvanendran, Asokumar, MD; Gupta, Rajnish, MD§; Chont, Melissa, MLAS§; Kennedy, Mary, RN; Bruehl, Stephen, PhD§

The Clinical Journal of Pain: July 2019 - Volume 35 - Issue 7 - p 569–576
doi: 10.1097/AJP.0000000000000711
Original Articles
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Objectives: Sleep disturbance and chronic pain are related. The present study evaluated both direct and indirect (mediated) pathways through which sleep disturbance might be related to chronic pain intensity and function.

Methods: In total, 87 individuals (64% female) with chronic low back pain but not using opioids daily completed questionnaires assessing their sleep disturbance, chronic pain intensity, function, depression, anxiety, positive affect, and catastrophizing.

Results: Greater sleep disturbance was associated with greater pain intensity, worse function, greater emotional distress, lower positive affect, and higher levels of catastrophizing. Cross-sectional mediation analyses revealed that the positive associations between sleep disturbance and chronic pain intensity were conveyed statistically not only by significant indirect effects of elevated emotional distress, lower positive affect, and greater catastrophizing associated with sleep disturbance, but also by significant direct effects of sleep disturbance on chronic pain intensity. Similarly, we found that the associations between sleep disturbance and impaired function were conveyed statistically not only by significant indirect effects of elevated chronic pain intensity associated with sleep disturbance, but also by significant direct effects of sleep disturbance on function.

Discussion: Sleep disturbance was related significantly with chronic pain intensity and function by both direct and indirect pathways. These results are consistent with an emerging literature highlighting the potential significance of sleep disturbance in chronic pain patients, and provide further support for addressing sleep disturbance in the assessment and management of chronic pain.

*Department of Psychiatry, University of Michigan, Ann Arbor, MI

Departments of Behavioral Sciences

Anesthesiology, Rush University Medical Center, Chicago, IL

§Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN

Supported by R01-DA031726 and R01-DA037891 from the National Institute on Drug Abuse/NIH, Bethesda.

H.J.B. is a consultant for Natrol, LLC. S.B. is a consultant for Grunenthal and BioHaven. The remaining authors declare no conflict of interest.

Reprints: Stephen Bruehl, PhD, Vanderbilt University Medical Center, 701 Medical Arts Building, 1211 Twenty-First Avenue South, Nashville, TN 37212 (e-mail: Stephen.Bruehl@vumc.org).

Received November 8, 2018

Received in revised form January 18, 2019

Accepted March 3, 2019

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