Articlegreen2012

Deciphering the Temporal Link between Pain and Sleep in a Heterogeneous Chronic Pain Patient Sample: A Multilevel Daily Process Study

Nicole K. Y. Tang · Claire E. Goodchild · Adam N. Sanborn · Paul Martin Salkovskis

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Abstract

OBJECTIVES: Because insomnia is a common comorbidity of chronic pain, scientific and clinical interest in the relationship of pain and sleep has surged in recent years. Although experimental studies suggest a sleep-interfering property of pain and a pain-enhancing effect of sleep deprivation/fragmentation, the temporal association between pain and sleep as experienced by patients is less understood. The current study was conducted to examine the influence of presleep pain on subsequent sleep and sleep on pain reports the next day, taking into consideration other related psychophysiologic variables such as mood and arousal. DESIGN: A daily process study, involving participants to monitor their pain, sleep, mood, and presleep arousal for 1 wk. Multilevel modeling was used to analyze the data. SETTING: In the patients' natural living and sleeping environment. PATIENTS: One hundred nineteen patients (73.9% female, mean age = 46 years) with chronic pain and concomitant insomnia. MEASUREMENT: An electronic diary was used to record patients' self-reported sleep quality/efficiency and ratings of pain, mood, and arousal at different times of the day; actigraphy was also used to provide estimates of sleep efficiency. RESULTS: Results indicated that presleep pain was not a reliable predictor of subsequent sleep. Instead, sleep was better predicted by presleep cognitive arousal. Although sleep quality was a consistent predictor of pain the next day, the pain-relieving effect of sleep was only evident during the first half of the day. CONCLUSIONS: These findings challenge the often-assumed reciprocal relationship between pain and sleep and call for a diversification in thinking of the daily interaction of these 2 processes.

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References

1983The Hospital Anxiety and Depression Scale 2002The validity of the Hospital Anxiety and Depression Scale 2001Validation of the Insomnia Severity Index as an outcome measure for insomnia research 2003The Role of Actigraphy in the Study of Sleep and Circadian Rhythms 2002A cognitive model of insomnia 2009The hyperarousal model of insomnia: A review of the concept and its evidence 2001Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients 1995The Role of Actigraphy in the Evaluation of Sleep Disorders

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