Five to 8% of youth report severe chronic pain and disability. Sleep deficiency, including reduced quantity and quality of sleep, is common and highly comorbid in an estimated 50% of youth with chronic pain. Sleep deficiency contributes to greater disability, poorer quality of life, and increased health care use. History of childhood chronic pain places youth at risk for a lifelong pattern of pain and disability and high health care costs in adulthood. Thus, finding effective methods that support youth in the self-management of pain is a priority. Although progress has been made in establishing pain self-management interventions for youth, treatments produce small to moderate effect sizes, and there is tremendous variability in patient response. Our preliminary data suggest that youth with greater sleep deficiency find pain self-management intervention less acceptable and make fewer gains in pain-related outcomes, indicating that sleep may represent an overlooked health factor influencing youth?s self-management skills. Sleep and pain share a bidirectional relationship, and data indicate that sleep deficiency increases pain sensitivity in adults and children. In addition to the direct effect of sleep on pain, sleep deficiency is associated with a number of areas that may influence self- management skills including deficits in complex cognitive functions and reduced self-regulatory skills. However, to date, studies have not determined the impact of sleep deficiency on self-management of pediatric chronic pain. Therefore, the objective of this application is to characterize how sleep deficiency influences youth?s ability to engage with, implement, and benefit from a pain self-management intervention. We will study a cohort of 80 youth, ages 12 to 17 years, with chronic musculoskeletal, head, or abdominal pain. Assessments will occur at baseline, immediately after intervention, and repeated at 3 months post-intervention. Mediators will be assessed at an additional mid-treatment (4 weeks) data point. All youth will receive an internet-delivered pain self-management intervention over an 8-week period. Following the recommended Common Data Elements for self-management we measure three self-management processes including patient activation, pain self-efficacy, and self-management skills, and assess patient-reported outcomes of health (global health, fatigue) and pain (pain symptoms, pain-related disability). Positive and negative affect will be assessed as potential mediators. Sleep deficiency will be comprehensively assessed with subjective measures, daily sleep logs, and ambulatory actigraphy monitoring to measure disrupted sleep, amount of sleep, sleep quality, and insomnia symptoms. By identifying the effects of sleep deficiency on youth?s ability to engage with and acquire pain self-management skills, we will gain novel insight needed to develop a tailored self-management program for youth with comorbid chronic pain and sleep deficiency in a subsequent R01 using a large-scale RCT.
Sleep deficiency, including reduced quantity and quality of sleep, is common and highly comorbid in an estimated 50% of youth with chronic pain. The proposed project will determine how sleep deficiency influences youth?s ability to engage with, implement, and benefit from a pain self-management intervention. The long-term goal of the research is to develop effective, tailored self-management interventions that can address comorbid sleep deficiency and interrupt a cycle of persistent, disabling pain from continuing into adulthood.
