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Thompson P, Friesen HJ, Schurman JV, Colombo JM, Friesen CA. A Cross-Sectional Study of Sleep Disturbances in Children and Adolescents With Abdominal Pain-Associated Disorders of Gut-Brain Interaction. Clin Pediatr (Phila) 2024; 63:697-702. [PMID: 37461213 DOI: 10.1177/00099228231187226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The aims of the current study were to determine the frequencies of specific sleep disturbances in youth with abdominal pain-associated disorders of gut-brain interaction (AP-DGBIs) and to assess relationships with psychological dysfunction. This was a retrospective evaluation of 226 consecutive patients diagnosed with an AP-DGBI. All had undergone a systematic evaluation of gastrointestinal symptoms, the Sleep Disturbance Scale for Children, and the Behavior Assessment System for Children. Disorders of initiation and maintenance of sleep (DIMS; 40%) and disorders of excessive daytime somnolence (DOES; 14%) were each present in more than 10% of the patients. Both DIMS and DOES scores were more likely to be elevated in patients with anxiety and/or depression scores in the at-risk or elevated-risk ranges. Sleep disorders are common in youth with AP-DGBIs and are associated with anxiety and depression, even in those patients with anxiety and depression in the at-risk range.
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Affiliation(s)
- Pierce Thompson
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
| | | | - Jennifer V Schurman
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jennifer M Colombo
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Craig A Friesen
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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2
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Cao W, Li X, Yan Y, Zhou J, Ye J, Lv Q. Changes in sleep patterns in primary care workers during the first wave of the COVID-19 pandemic in 2022 in Shanghai: a cross-sectional study. Sci Rep 2024; 14:12373. [PMID: 38811616 PMCID: PMC11137069 DOI: 10.1038/s41598-024-61311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/03/2024] [Indexed: 05/31/2024] Open
Abstract
The coronavirus disease (COVID-19) pandemic has significantly affected the sleep health of healthcare workers (HCWs); however, no studies have assessed this effect in primary HCWs. This cross-sectional, web-based study explored the prevalence and factors associated with sleep disorders among primary HCWs during the first COVID-19 outbreak in Shanghai from 12 July to 15 August 2022. Sociodemographic and work-related characteristics, various sleep dimensions, and exposure to patients with COVID-19 were assessed. They were screened for common mental disorders (depression, burnout, and stress). Overall, 313 primary HCWs were recruited. At least one sleep dimension in 84% of respondents deteriorated compared with that observed pre-pandemic; sleep quality (decline of 66%) and daytime sleepiness (increase of 56%) were the most affected domains. After excluding 145 primary HCWs with pre-pandemic 'poor sleep', depression (odds ratio [OR] 3.08; 95% confidence interval [CI] 1.59-5.98), weekly burnout symptoms (OR 2.57; 95% CI 1.32-5.03), and high psychological stress (OR 4.51; 95% CI 2.09-9.72) were associated with poor sleep patterns during the pandemic. After adjusting for significant differences between groups, for every 1-point increase in the Perceived Stress Scale score, an associated 12% increased risk of poor sleep (adjusted OR 1.12; 95% CI 1.05-1.21; p = 0.002) was observed. Most primary HCWs showed significant worsening of sleep quality, with increases in daytime sleepiness during the first wave of the COVID-19 pandemic in Shanghai. HCWs with high stress levels were at greater risks of sleep disorders.
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Affiliation(s)
- Wenshu Cao
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China
| | - Xiaoting Li
- Nanhui New Town Community Health Service Center of Pudong New Area, 280 Chaohe Road, Shanghai, China
| | - Yini Yan
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China
| | - Jianfeng Zhou
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China
| | - Jizhong Ye
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China.
| | - Qiwei Lv
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China.
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3
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Arnison T, Evans B, Schrooten MGS, Persson J, Palermo TM. Adolescent Girls' Musculoskeletal Pain is More Affected by Insomnia Than Boys, and Through Different Psychological Pathways. THE JOURNAL OF PAIN 2024:104571. [PMID: 38763259 DOI: 10.1016/j.jpain.2024.104571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
Prior research has established that insomnia is predictive of pain in adolescents and that psychological mechanisms have a crucial role in this relationship. Adolescent girls report more insomnia and pain than boys, yet little is known of gender differences in how insomnia influences pain. This study assessed gender differences in levels and trajectories of insomnia and pain during adolescence, and whether rumination and negative mood mediated the effect of insomnia on pain. Longitudinal survey data measured on 5 annual occasions (Nbaseline = 2,767) were analyzed in a multigroup longitudinal serial mediation model. A final model was generated with insomnia as the predictor, rumination and depressed mood as mediators, pain as the outcome, and gender as the grouping variable. The results showed that insomnia predicted pain in adolescents, with an effect 3.5 times larger in girls than boys. Depressed mood was the main mediator in boys. In girls, rumination was the only significant mediator. There were significant gender differences in the effects of insomnia on rumination and pain, and in the effects of rumination on depressed mood and pain, with stronger effects in girls. These results highlight that girls and boys should be considered separately when studying the relationship between insomnia and pain. PERSPECTIVE: Levels of insomnia and pain are progressively higher in adolescent girls than boys, across adolescence. The predictive strength of insomnia symptoms for future pain is 3.5 times greater in girls, with distinct gender-specific underlying pathways: rumination partially mediates this effect in girls, while depressed mood does so in boys.
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Affiliation(s)
- Tor Arnison
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Örebro County, Sweden; School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Örebro County, Sweden.
| | - Brittany Evans
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Örebro County, Sweden
| | - Martien G S Schrooten
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Örebro County, Sweden
| | - Jonas Persson
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Örebro County, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology, Pediatrics & Psychiatry, University of Washington School of Medicine, Seattle, Washington
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Gyasi RM, Aikins E, Dumedah G, Gyasi-Boadu N, Frimpong PB, Boampong MS, Buor D, Mariwah S, Naab F, Phillips DR. Risk of Sleep Problems in Middle-Aged and Older Adults Experiencing Bodily Pains: Serial Multiple Mediation Estimates of Emotional Distress and Activity Limitations. Am J Geriatr Psychiatry 2024:S1064-7481(24)00318-X. [PMID: 38702252 DOI: 10.1016/j.jagp.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES Pain is increasingly becoming common among middle-aged and older adults. While research on the association between pain characteristics and sleep problems (SP) is limited in low- and middle-income countries, the underlying mechanisms of the association are poorly understood. This study examines the association of bodily pain intensity and pain interference with SP and investigates the mediating role of activity limitation and emotional distress in this association. METHODS We analyzed population-based data, including 1,201 individuals aged ≥50 (mean [SD] age 66.14 [11.85] years) from the 2016-2018 AgeHeaPsyWel-HeaSeeB study in Ghana. Multiple OLS regressions and serial multiple mediation modeling using bootstrapping analyses examined direct and indirect effects from pain to SP through activity limitation and emotional distress. RESULTS Regressions demonstrated that pain intensity and interference were significantly associated with higher levels of activity limitation, emotional distress, and SP (range: β = 0.049-0.658). Bootstrapping analysis showed that activity limitation and emotional distress serially mediated the relationship between pain intensity and SP (total effect: β = 0.264, Bootstrap 95% confidence interval [CI] = 0.165-0.362; direct effect: (β = 0.107, Bootstrap 95% CI = 0.005-0.210; total indirect effect: β = 0.156, Bootstrap 95% CI = 0.005-0.210) accounting for ∼59%. Activity limitation and emotional distress mediated pain interference and SP association (total effect: β = 0.404, Bootstrap 95% CI = 0.318-0.490; direct effect: β = 0.292, Bootstrap 95% CI = 0.201-0.384; and total indirect effect: β = 0.112, Bootstrap 95% CI = 0.069-0.156) yielding ∼28%. CONCLUSION Our data suggest that activity limitation and emotional distress may convey stress-related risks of pain on SP. Future research should evaluate if activity limitation and emotional distress could be effective targets to reduce the effect of pain on sleep in later-life.
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Affiliation(s)
- Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya; National Centre for Naturopathic Medicine (NCNM), Southern Cross University, Lismore, Australia.
| | - Emelia Aikins
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gift Dumedah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nelson Gyasi-Boadu
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Prince Boakye Frimpong
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mary Sefa Boampong
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Buor
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Simon Mariwah
- Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
| | - Francis Naab
- Perivoli Africa Research Centre (PARC), University of Bristol, Bristol, United Kingdom
| | - David R Phillips
- Department of Sociology and Social Policy, Lingnan University, Hong Kong, Hong Kong
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Nania C, Noyek SE, Soltani S, Katz J, Fales JL, Birnie KA, Orr SL, McMorris CA, Noel M. Peer Victimization, Posttraumatic Stress Symptoms, and Chronic Pain: A Longitudinal Examination. THE JOURNAL OF PAIN 2024:104534. [PMID: 38615800 DOI: 10.1016/j.jpain.2024.104534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
Chronic pain and posttraumatic stress disorder symptoms (PTSS) co-occur at high rates in youth and are linked to worse pain outcomes and quality of life. While peer victimization has been posited as a mechanism underlying the PTSS-pain relationship in youth, empirical evidence suggests that it may exacerbate both PTSS and pain. The present study aimed to longitudinally examine PTSS as a mediator in the relationship between peer victimization at baseline and pain-related outcomes at 3 months in youth with chronic pain. Participants included 182 youth aged 10 to 18 years recruited from a tertiary-level children's hospital in Western Canada. At baseline, participants completed measures to assess pain (intensity and interference), peer victimization (relational and overt), and PTSS. The pain was reassessed at a 3-month follow-up. Primary hypotheses were tested utilizing a series of mediation analyses with PTSS as a proposed mediator in the associations between peer victimization and pain outcomes. Youth PTSS mediated the relationship between higher baseline relational victimization and higher 3-month pain interference while controlling for baseline pain interference. Three-month pain intensity was not correlated with peer victimization; thus, pain intensity was not included in the analyses. These findings reveal that PTSS may be an underlying factor in the co-occurrence of peer victimization and chronic pain in youth. Further research is needed to better understand the role of peer victimization in the maintenance of chronic pain to ensure appropriate, effective, and timely interventions that address the social and mental health issues impacting the lives of these youth as well as their pain. PERSPECTIVE: PTSS may be an underlying factor in the co-occurrence between peer victimization and chronic pain in youth, highlighting the need to assess for both peer relationship problems and PTSS in youth with chronic pain.
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Affiliation(s)
- Cara Nania
- School and Applied Child Psychology, Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - Samantha E Noyek
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Jessica L Fales
- Department of Psychology, Washington State University, Vancouver, Washington
| | - Kathryn A Birnie
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Serena L Orr
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carly A McMorris
- School and Applied Child Psychology, Werklund School of Education, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Hildenbrand AK, Amaro CM, Bear B, Soprano CM, Salamon KS. Exploring Referral and Service Utilization Patterns Within an Outpatient Interdisciplinary Pediatric Chronic Pain Program. J Pain Res 2024; 17:525-533. [PMID: 38333433 PMCID: PMC10849913 DOI: 10.2147/jpr.s430411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/21/2023] [Indexed: 02/10/2024] Open
Abstract
Purpose We examine referral sources and clinical characteristics for youth presenting to an outpatient interdisciplinary pediatric chronic pain program. Patients and Methods Referral data were extracted from the electronic health record. PROMIS Pediatric Anxiety and Pain Interference Scales were administered at an initial evaluation visit. Results The program received 1488 referrals between 2016 and 2019, representing 1338 patients, with increasing volume of referrals over time. Referrals were primarily from orthopedics (19.6%), physical medicine and rehabilitation (18.8%), neurology (14.4%), and rheumatology (12.6%). Patients referred were primarily female (75.4%), White (80.1%), English-speaking (98.4%) adolescents (median=15.0 years). Of those referred, 732 (54.7%) attended an interdisciplinary evaluation (ie, with ≥2 disciplines). Adolescent anxiety was within the expected range by self-report (N=327, MT-score=55.67) and parent proxy-report (N=354, MT-score=57.70). Pain interference was moderately elevated by self-report (N=323, MT-score=61.52) and parent proxy-report (N=356, MT-score=64.02). There were no differences between patients referred who attended versus did not attend an interdisciplinary evaluation based on age, sex, ethnicity, or language. A smaller than expected proportion of referred Black patients (44%, P=0.02) and patients referred from orthopedics (40%) or pulmonology (11%) attended an evaluation, whereas a larger than expected proportion of those referred from physical medicine and rehabilitation (78%) were evaluated (P<0.001). Conclusion Results highlight the demand for outpatient interdisciplinary pediatric chronic pain treatment. Findings can inform decisions related to staffing and service design for pediatric hospitals that aim to establish or grow outpatient pediatric chronic pain programs.
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Affiliation(s)
- Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Division of Behavioral Health, Nemours Children’s Hospital Delaware, Wilmington, DE, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christina M Amaro
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Benjamin Bear
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Catherine M Soprano
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Division of Diagnostic Referral, Nemours Children’s Hospital Delaware, Wilmington, DE, USA
| | - Katherine S Salamon
- Division of Behavioral Health, Nemours Children’s Hospital Delaware, Wilmington, DE, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Roman-Juan J, Solé E, Sánchez-Rodríguez E, Castarlenas E, Jensen MP, Miró J. Adverse Childhood Events and Chronic Pain in Adolescents: The Role of Sleep Disturbance. J Pediatr Psychol 2023; 48:931-939. [PMID: 37743052 DOI: 10.1093/jpepsy/jsad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVES This study aimed to (1) examine the extent to which the association between exposure to adverse childhood events (ACEs) and having chronic pain in adolescents is explained by the association between exposure to ACEs and sleep disturbance and (2) explore the role of sleep disturbance in the association between exposure to ACEs and anxiety and depressive symptoms in adolescents with chronic pain. METHODS Cross-sectional data from 469 adolescents aged 13-18 years old were drawn from an epidemiological study on pediatric chronic pain conducted in Catalonia (Spain). Participants provided self-reports of demographic characteristics, exposure to ACEs, pain characteristics, sleep disturbance, anxiety, and depressive symptoms. Mediation and moderation models were conducted. RESULTS Sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and the presence of chronic pain. Moreover, sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and depressive symptoms and moderated the association between exposure to ACEs and anxiety in adolescents with chronic pain. CONCLUSION The study findings suggest the possibility that addressing sleep disturbance in adolescents exposed to ACEs may help to prevent the development of chronic pain, anxiety, and depressive symptoms in those adolescents who already have chronic pain.
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Affiliation(s)
- Josep Roman-Juan
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, USA
| | - Jordi Miró
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
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Bedree H, Tran ST, Koven ML, Wershil SJ, Fortunato JE, Essner BS. Impact of Sleep Disturbance on Fatigue, Nausea, and Pain: Mediating Role of Depressive Symptoms Among Youth With Disorders of Gut-Brain Interaction. J Pediatr Gastroenterol Nutr 2023; 77:468-473. [PMID: 37434286 DOI: 10.1097/mpg.0000000000003887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVES A high degree of sleep disturbance is reported among youth with disorders of gut-brain interaction (DGBIs). Given that sleep quality impacts a range of pediatric health outcomes including somatic sensations (eg, pain) and depressive mood occurs relatively frequently among youth with DGBIs, there is a dire need to disentangle the unique contributions of sleep and depressive mood on the somatic sensations experienced by youth with DGBIs. We aimed to examine whether depressive mood mediates the relations among sleep disturbance and pain intensity, nausea, and fatigue among youth with DGBIs. METHODS One hundred eighteen patients aged 8-17 years ( Mage = 14.05, SD = 2.88; 70.34% female), 83.05% White/non-Hispanic recruited at a pediatric neurogastroenterology clinic completed measures of sleep disturbance, nausea, fatigue, pain intensity, and depressive mood. Three mediation models examined the effect of sleep disturbance on nausea, fatigue, and pain, with depressive mood as a mediator. RESULTS Participants reported moderate sleep disturbance. Depressive mood partially mediated the significant, respective relations between greater sleep disturbance and more severe nausea and fatigue. Sleep disturbance was significantly associated with higher pain intensity; however, depressive mood was not a significant mediator of this relation. CONCLUSIONS Sleep quality is a major concern among youth with DGBIs. Low sleep quality may worsen nausea and fatigue via co-occurring increases in depressive mood symptoms. In contrast, sleep disturbance may directly increase pain, regardless of youths' depressive mood symptoms. Future research should explore these relations through prospective studies leveraging a combination of subjective and objective assessment approaches.
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Affiliation(s)
- Helen Bedree
- From the Department of Psychology, DePaul University, Chicago, IL
| | - Susan T Tran
- From the Department of Psychology, DePaul University, Chicago, IL
| | - Marissa L Koven
- From the Department of Psychology, DePaul University, Chicago, IL
| | - Sarah J Wershil
- From the Department of Psychology, DePaul University, Chicago, IL
- the Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- the Pritzker Department of Psychiatry & Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John E Fortunato
- the Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bonnie S Essner
- the Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Pritzker Department of Psychiatry & Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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9
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Arnison T. Prevention is better than cure: why early interventions for insomnia and chronic pain during adolescence should be a priority. Front Psychol 2023; 14:1206977. [PMID: 37359854 PMCID: PMC10285456 DOI: 10.3389/fpsyg.2023.1206977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
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10
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Pico M, Matey-Rodríguez C, Domínguez-García A, Menéndez H, Lista S, Santos-Lozano A. Healthcare Professionals’ Knowledge about Pediatric Chronic Pain: A Systematic Review. CHILDREN 2023; 10:children10040665. [PMID: 37189914 DOI: 10.3390/children10040665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
Pediatric chronic pain is a common public health problem with a high prevalence among children and adolescents. The aim of this study was to review the current knowledge of health professionals on pediatric chronic pain between 15–30% among children and adolescents. However, since this is an underdiagnosed condition, it is inadequately treated by health professionals. To this aim, a systematic review was carried out based on a search of the electronic literature databases (PubMed and Web of Science), resulting in 14 articles that met the inclusion criteria. The analysis of these articles seems to show a certain degree of heterogeneity in the surveyed professionals about the awareness of this concept, especially regarding its etiology, assessment, and management. In addition, the extent of knowledge of the health professionals seems to be insufficient regarding these aspects of pediatric chronic pain. Hence, the knowledge of the health professionals is unrelated to recent research that identifies central hyperexcitability as the primary factor affecting the onset, persistence, and management of pediatric chronic pain.
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Affiliation(s)
- Mónica Pico
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Carmen Matey-Rodríguez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Ana Domínguez-García
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Héctor Menéndez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Simone Lista
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
- Research Institute of the Hospital 12 de Octubre (‘imas12’), 28041 Madrid, Spain
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11
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Albinni B, de Zambotti M, Iacovides S, Baker FC, King CD. The complexities of the sleep-pain relationship in adolescents: A critical review. Sleep Med Rev 2023; 67:101715. [PMID: 36463709 PMCID: PMC9868111 DOI: 10.1016/j.smrv.2022.101715] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Chronic pain is a common and disabling condition in adolescents. Disturbed sleep is associated with many detrimental effects in adolescents with acute and chronic pain. While sleep and pain are known to share a reciprocal relationship, the sleep-pain relationship in adolescence warrants further contextualization within normally occurring maturation of several biopsychological processes. Since sleep and pain disorders begin to emerge in early adolescence and are often comorbid, there is a need for a comprehensive picture of their interrelation especially related to temporal relationships and mechanistic drivers. While existing reviews provide a solid foundation for the interaction between disturbed sleep and pain in youth, we will extend this review by highlighting current methodological challenges for both sleep and pain assessments, exploring the recent evidence for directionality in the sleep-pain relationship, reviewing potential mechanisms and factors underlying the relationship, and providing direction for future investigations. We will also highlight the potential role of digital technologies in advancing the understanding of the sleep and pain relationship. Ultimately, we anticipate this information will facilitate further research and inform the management of pain and poor sleep, which will ultimately improve the quality of life in adolescents and reduce the risk of pain persisting into adulthood.
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Affiliation(s)
- Benedetta Albinni
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Department of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | | | - Stella Iacovides
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Behavioral Medicine and Clinical Psychology, Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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12
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Klages KL, Chardon ML, Drake SN, Myers KC, Morrison CF, Pai AL. Pain, depressive symptoms, and health-related quality of life among survivors of pediatric hematopoietic stem cell transplant. Pediatr Blood Cancer 2022; 69:e29846. [PMID: 35730649 PMCID: PMC9420784 DOI: 10.1002/pbc.29846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Pediatric hematopoietic stem cell transplant (HCT) is an intensive medical procedure associated with significant late effects, of which pain is a prominent example. While pain is associated with increased depressive symptoms and health-related quality-of-life (HRQoL) impairments in other pediatric chronic illness populations, associations between these variables are not well understood in pediatric HCT. Clarifying these associations may inform clinical interventions to improve health outcomes following pediatric HCT. This study aimed to investigate the relations between pain intensity, depressive symptoms, and HRQoL in survivors of pediatric HCT. METHOD Fifty-one survivors of pediatric HCT (Mage = 14.3 years, standard deviation [SD] = 4.3; 58.8% male; 80.4% White) completed self-report measures of pain intensity, depressive symptoms, and HRQoL. Demographic and disease information was collected via demographic forms and medical record review. Path analysis was used to examine hypothesized associations between pain intensity, depressive symptoms, and HRQoL. RESULTS Analyses revealed direct effects of pain intensity on depressive symptoms (estimate [Est.] = .23, p < .001) and HRQoL (Est. = -.2, p = .04), and direct effects of depressive symptoms on HRQoL (Est. = -.68, p < .001). Depressive symptoms also mediated the relationship between pain intensity and HRQoL (Est. = -.16, p = .006). CONCLUSIONS Greater pain intensity was associated directly with increased depressive symptoms and indirectly with HRQoL through depressive symptoms. Results of this study suggest that multitargeted cognitive behavioral interventions that address pain and depressive symptoms may improve HRQoL ratings in survivors of pediatric HCT.
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Affiliation(s)
- Kimberly L. Klages
- Behavioral Medicine and Clinical Psychology & Patient and Family Wellness Center for Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229
| | - Marie L. Chardon
- Behavioral Medicine and Clinical Psychology & Patient and Family Wellness Center for Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229
| | - Sarah N. Drake
- Behavioral Medicine and Clinical Psychology & Patient and Family Wellness Center for Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229
| | - Kasiani C. Myers
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267
| | | | - Ahna L.H. Pai
- Behavioral Medicine and Clinical Psychology & Patient and Family Wellness Center for Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267
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13
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Morris EE, Howell MJ, Pickup E, Iber C, Wang SG. Pediatric sleep and pain: etiologies, consequences, and clinical considerations. J Clin Sleep Med 2022; 18:2281-2289. [PMID: 35499282 PMCID: PMC9435332 DOI: 10.5664/jcsm.10008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine current evidence of the relationship between sleep and pain from the neonatal period through adolescence. This review serves as a critical review of the literature and of the needs for future research on pediatric sleep and pain. METHODS The PubMed online database was queried from January 1, 1960, to March 1, 2020, producing 149 articles applicable to pain and sleep in the pediatric population. Of those, 97 articles were cited in this review with the key articles including over 3800 participants. RESULTS The pediatric literature supports the relationship between poor sleep (both sleep efficiency and nighttime awakenings) and subsequent risk for pain, especially among children with chronic disease. The reverse effect of pain on sleep is not yet well delineated. The key moderating factors explored in the literature are pharmacologic and nonpharmacologic therapies, psychologic health, and the etiology of pain. There is evidence that both altered sleep and pain early in life impact neurodevelopment, as seen by changes in sleep structure in clinical studies and alterations in brain development in animal models. CONCLUSIONS The complicated relationship between sleep and pain is critically important during pediatric development when alterations to a normal sleep structure can have a lifelong impact. It is becoming clear that sleep deprivation and poor sleep quality exacerbate pain. Further research is needed into the complex alterations of sleep in chronic pain conditions as well as treatments to improve sleep in pediatric care. CITATION Morris EE, Howell MJ, Pickup E, Iber C, Wang SG. Pediatric sleep and pain: etiologies, consequences, and clinical considerations. J Clin Sleep Med. 2022;18(9):2281-2289.
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Affiliation(s)
- Erin E. Morris
- Department of Pediatrics, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| | - Michael J. Howell
- Department of Neurology, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| | - Elizabeth Pickup
- Pediatric Neurology, Children’s National Hospital, Washington, DC
| | - Conrad Iber
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| | - Sonya G. Wang
- Department of Pediatrics, University of Minnesota–Twin Cities, Minneapolis, Minnesota
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14
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Arnison T, Schrooten MGS, Hesser H, Jansson-Fröjmark M, Persson J. Longitudinal, bidirectional relationships of insomnia symptoms and musculoskeletal pain across adolescence: the mediating role of mood. Pain 2022; 163:287-298. [PMID: 34001767 DOI: 10.1097/j.pain.0000000000002334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Previous studies have established a bidirectional relationship between sleep and pain, and mood has been proposed as a mediator of this relationship. There are only a limited number of longitudinal studies examining the mediational role of mood, and the directionality of effects between sleep, pain, and mood is uncertain. In addition, despite the high prevalence of pain and sleep problems during adolescence, these relationships have rarely been examined in a longitudinal sample of adolescents. Here, longitudinal survey data with 5 yearly measurements were used to examine the bidirectional relationship between insomnia symptoms and pain across adolescence (Mbaseline age = 13.65 years, Nbaseline = 2767). We also explored if depressed mood, positive affect, and anxious mood are mediators in both directions of the sleep-pain relationship. Using latent variables for insomnia, pain, and mood at multiple time points, the data were analyzed with cross-lagged panel models for longitudinal data with structural equation modeling. Current results confirmed a bidirectional relationship between insomnia symptoms and pain, where the effect of insomnia symptoms on pain was stronger than vice versa. Depressed mood and anxious mood mediated the effect of insomnia symptoms on pain, but not the reverse effect of pain on insomnia symptoms. Positive affect did not serve as a mediator in either direction. These findings add novel insights into the temporal directionality of sleep, pain, and mood during adolescence, suggesting a temporal path from sleep to pain, through mood, rather than a reciprocal relationship between the constructs.
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Affiliation(s)
- Tor Arnison
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | | | - Hugo Hesser
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Jonas Persson
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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15
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Solé E, Sharma S, Ferreira-Valente A, Pathak A, Sánchez-Rodríguez E, Jensen MP, Miró J. The associations between sleep disturbance, psychological dysfunction, pain intensity, and pain interference in children with chronic pain. PAIN MEDICINE 2021; 23:1106-1117. [PMID: 34850200 DOI: 10.1093/pm/pnab333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study aimed to better understand the associations between both sleep disturbance and psychological dysfunction (i.e., anxiety and depressive symptoms, and anger), and pain intensity and pain interference, in a sample of children with chronic pain. DESIGN Cross-sectional design. METHODS Three hundred and forty-two children with chronic pain (8-18 years) completed measures assessing pain intensity, pain interference, sleep disturbance, anxiety, depressive symptoms, and anger. Regression analyses examined the direct, interaction (with sex), and mediation effects of sleep quality and psychological dysfunction on pain intensity and interference. RESULTS Sleep disturbance was significantly associated with both pain intensity and pain interference. However, measures of psychological dysfunction were associated significantly only with pain interference. Sex did not moderate these associations. The measures of psychological dysfunction mediated the associations between sleep disturbance and pain interference, but not those between sleep disturbance and pain intensity. CONCLUSIONS The results confirmed significant cross-sectional associations between both sleep disturbance and psychological dysfunction and pain outcomes in children with chronic pain. Future research to test for causal associations is warranted.
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Affiliation(s)
- Ester Solé
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Saurab Sharma
- Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Alexandra Ferreira-Valente
- William James Center for Research, ISPA - Instituto Universitário, Lisbon, Portugal.,Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Anupa Pathak
- Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
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16
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Wiwe Lipsker C, Hirvikoski T, Balter LJT, Bölte S, Lekander M, Holmström L, Wicksell RK. Autistic Traits and Attention-Deficit Hyperactivity Disorder Symptoms Associated With Greater Pain Interference and Depression, and Reduced Health-Related Quality of Life in Children With Chronic Pain. Front Neurosci 2021; 15:716887. [PMID: 34790087 PMCID: PMC8591303 DOI: 10.3389/fnins.2021.716887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022] Open
Abstract
Previous research indicates elevated levels of clinically significant traits and symptoms of autism spectrum disorder and attention-deficit hyperactivity disorder (ADHD) in children with chronic pain, but associations with functioning and depression are yet unclear. The current study examined the relationships of autistic traits and ADHD symptoms with pain interference, depression, and health-related quality of life, as well as the mediating roles of insomnia and psychological inflexibility, in children with chronic pain (n = 146, 8–17 years, 102 girls) presenting at a tertiary pain clinic. Children completed measures of pain intensity, depression, pain interference, health-related quality of life, insomnia, and psychological inflexibility. Parents (n = 146, 111 mothers) completed measures to assess autistic traits and ADHD symptoms in their children. Children with clinically significant autistic traits and ADHD symptoms presented with significantly higher levels of depressive symptoms and pain interference, and significantly lower health-related quality of life, than did the other children. Autistic traits and ADHD symptoms contributed significantly to the prediction of pain interference and depressive symptoms, as well as health-related quality of life. Psychological inflexibility mediated the relationships between ADHD symptoms and autistic traits on the one hand and depression, pain interference, and health-related quality of life on the other, while insomnia mediated the relationships between ADHD symptoms and depression, pain interference, and health-related quality of life. All analyses were adjusted for demographics and pain intensity. Results suggest the utility of screening for neurodevelopmental disorders in children with chronic pain. Furthermore, the findings may indicate insomnia and skills related to psychological flexibility as potential treatment targets in interventions aiming at improving functioning and health-related quality of life in children with chronic pain and co-occurring symptoms of neurodevelopmental disorders.
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Affiliation(s)
| | - Tatja Hirvikoski
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Habilitation and Health, Stockholm, Sweden
| | - Leonie J T Balter
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Linda Holmström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Psychology, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Pain Clinic, Capio St. Göran's Hospital, Stockholm, Sweden
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17
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Orth Z, van Wyk B. Measuring mental wellness among adolescents living with a physical chronic condition: a systematic review of the mental health and mental well-being instruments. BMC Psychol 2021; 9:176. [PMID: 34749818 PMCID: PMC8576887 DOI: 10.1186/s40359-021-00680-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background Globally, promoting mental health and well-being among adolescents has become a public health priority, especially for adolescents living with a physical chronic condition (CC), as research suggests they may be more at risk of developing mental health co-morbidities. Valid and reliable instruments are needed to measure and better understand mental health and mental well-being among adolescents living with a CC. To this end, we reviewed studies reporting on mental health and well-being instruments used in adolescent populations living with a chronic physical condition/disease globally. Methods We used a systematic review method guided by PRISMA to identify assess mental health and mental well-being instruments used in adolescents living with a CC. In this instance, mental health instruments were defined as those representing negative domains of mental health (i.e. depression and anxiety) while mental well-being instruments included positive aspects of mental health (i.e. self-concept and resilience). Results We identified 22 articles, which included 31 instruments that were used to measure either mental health (n = 8) or mental well-being (n = 15) or both (n = 8) in adolescents living with a CC. Of these, thirteen studies used a Health-Related Quality of Life (HRQoL) scale to measure mental health and/or mental well-being. The KIDSCREEN questionnaires and the Strengths and Difficulties Questionnaire were identified as being frequently used across the 22 studies. Additionally, 7 out of the 31 instruments were disease specific, with 3 focusing on adolescents with diabetes. All the instruments were developed in high income countries and adapted for use in lower- and middle-income countries (LMICs). Adolescents with Type 1 Diabetes (n = 7) and HIV (n = 4) were researched in 11 out of 22 studies. Only eight studies were conducted in LMIC, of which four were in Africa. Conclusions HRQoL instruments are useful in measuring mental health and well-being in adolescents living with a CC. However, relatively few valid measures of mental health and mental well-being for adolescents living with a CC exist, which accentuates the paucity of research on mental health and mental well-being of adolescents who are living with a CC. Specific measures need to be developed in and for LMICs where cultural contexts affect mental well-being in unique ways. Systematic review registration: PROSPERO CRD42020186707.
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Affiliation(s)
- Zaida Orth
- School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville, 7535, South Africa.
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville, 7535, South Africa
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18
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Matthews E, Muldoon M, O'Keeffe N, McCarthy KF. Social deprivation and paediatric chronic pain referrals in Ireland: a cross-sectional study. Scand J Pain 2021; 21:597-605. [PMID: 34080402 DOI: 10.1515/sjpain-2021-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Social deprivation is associated with a higher prevalence of chronic pain in children and an under-representation in specialist paediatric chronic pain programs. Our primary objective was to determine if there was a relationship between social deprivation and paediatric chronic pain referrals in Ireland. Secondary objectives included analysing for differences between deprivation groups in pain characteristics and function that are recorded at first clinic visit. METHODS Families attending the national paediatric complex pain service in Dublin, Ireland, complete questionnaires on pain characteristics, parental pain catastrophizing, and pain-related disability including sleep quality and school attendance. We retrospectively reviewed records from between February 2016 and November 2019 on 288 patients. Social deprivation was assessed using the Pobal HP Deprivation Index, which is based on data from the Irish national census. RESULTS Referrals followed a normal distribution across deprivation grades. Children in the disadvantaged group had a longer duration of pain, greater use of screens at bedtime, and longer sleep onset latency. Parents in the disadvantaged group had significantly higher levels of parental pain catastrophizing. CONCLUSIONS In Ireland, while paediatric chronic pain referrals were normally distributed across deprivation group, the disadvantaged group was different in several ways that may be clinically significant. Further work will be needed to determine the longitudinal relationship between these factors before and after the referral and initial review. Screening for, and targeting, potential risk factors for pain chronicity may be needed to harmonize treatment outcomes in children from socially disadvantaged families.
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Affiliation(s)
| | - Maeve Muldoon
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Norma O'Keeffe
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Kevin F McCarthy
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple Street, Dublin, Ireland.,Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
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19
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Towards the endotyping of the sleep-pain interaction: a topical review on multitarget strategies based on phenotypic vulnerabilities and putative pathways. Pain 2021; 162:1281-1288. [PMID: 33105436 DOI: 10.1097/j.pain.0000000000002124] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
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20
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Mahmoudi H, Saffari M, Movahedi M, Sanaeinasab H, Rashidi-Jahan H, Pourgholami M, Poorebrahim A, Barshan J, Ghiami M, Khoshmanesh S, Potenza MN, Lin CY, Pakpour AH. A mediating role for mental health in associations between COVID-19-related self-stigma, PTSD, quality of life, and insomnia among patients recovered from COVID-19. Brain Behav 2021; 11:e02138. [PMID: 33811451 PMCID: PMC8119851 DOI: 10.1002/brb3.2138] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/07/2021] [Accepted: 03/16/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Patients with COVID-19 often suffer from psychological problems such as post-traumatic stress disorder (PTSD) and self-stigmatization that may negatively impact their quality of life and sleep. This study examined mental health as a potential mediating factor linking self-stigmatization and PTSD to quality of life and sleep. METHODS Using a cross-sectional design, 844 people who had recovered from COVID-19 were called and interviewed. Data were collected using structured scales. Structural equation modeling was applied to assess fitness of a mediation model including self-stigma and PTSD as independent factors and quality of life and insomnia as dependent variables. RESULTS Mental health, COVID-19-related self-stigma, and mental quality of life were associated. Insomnia, PTSD, and COVID-19-related self-stigma displayed significant direct associations (r = .334 to 0.454; p < .01). A mediation model indicated satisfactory goodness of fit (CFI = 0.968, TLI = 0.950, SRMR = 0.071, RMSEA = 0.068). Mental health as a mediator had negative relationships with COVID-19-related self-stigma, PTSD, and insomnia and positive associations with quality of life. CONCLUSION Mental health may mediate effects of COVID-19-related self-stigma and PTSD on quality of life and insomnia. Designing programs to improve mental health among patients with COVID-19 may include efforts to reduce negative effects of PTSD and COVID-19-related self-stigma on quality of life and insomnia.
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Affiliation(s)
- Hosein Mahmoudi
- Trauma Research Center and Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahmoud Movahedi
- Behavioral Sciences Research Center and Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hormoz Sanaeinasab
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hojat Rashidi-Jahan
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Morteza Pourgholami
- Health Education and Health Promotion unit, Rasht Health Center,Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Poorebrahim
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Jalal Barshan
- Rasht Health Center,Guilan University of Medical Sciences, Rasht, Iran
| | - Milad Ghiami
- Health, Safety and Environment Management, Expert of Occupational Health of Health Center, Rasht, Iran
| | - Saman Khoshmanesh
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marc N Potenza
- Departments of Psychiatry and Neuroscience and the Child Study Center, School of Medicine, Yale University, New Haven, CT, USA
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, Department of Occupational Therapy, Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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21
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The Pittsburgh Sleep Quality Index: Reliability, Factor Structure, and Related Clinical Factors among Children, Adolescents, and Young Adults with Chronic Pain. SLEEP DISORDERS 2021; 2021:5546484. [PMID: 33996158 PMCID: PMC8096592 DOI: 10.1155/2021/5546484] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/03/2021] [Accepted: 04/16/2021] [Indexed: 11/20/2022]
Abstract
This study is aimed at assessing the psychometric properties and the factorial structure of the Pittsburgh Sleep Quality Index (PSQI) in a clinical sample of children, adolescents, and young adults with chronic pain. Data of 482 participants (aged 8-21 years) from two crosssectional studies and a chronic pain services outpatient clinic were analyzed. Exploratory and confirmatory factor analysis and reliability analysis of PSQI component scores were performed. Relationships between the PSQI global score and various clinical measures were investigated to assess external validity. The findings exhibit the reliability and validity of a single-factor model of the PSQI in a clinical sample of youth with chronic pain and support the relationship in this specific population between poor sleep quality and important clinical measures of well-being. These results support an informed decision regarding its use with this specific population and underscore the clinical relevance of assessing sleep quality.
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22
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Christensen J, Beveridge JK, Wang M, Orr SL, Noel M, Mychasiuk R. A Pilot Study Investigating the Role of Gender in the Intergenerational Relationships between Gene Expression, Chronic Pain, and Adverse Childhood Experiences in a Clinical Sample of Youth with Chronic Pain. EPIGENOMES 2021; 5:epigenomes5020009. [PMID: 34968296 PMCID: PMC8594698 DOI: 10.3390/epigenomes5020009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
Chronic pain is a highly prevalent and costly issue that often emerges during childhood or adolescence and persists into adulthood. Adverse childhood experiences (ACEs) increase risk for several adverse health conditions, including chronic pain. Recent evidence suggests that parental trauma (ACEs, post-traumatic stress disorder (PTSD) symptoms) confers risk of poor health outcomes in their children. Intergenerational relationships between parental trauma and child chronic pain may be mediated by epigenetic mechanisms. A clinical sample of youth with chronic pain and their parents completed psychometrically sound questionnaires assessing ACEs, PTSD symptoms, and chronic pain, and provided a saliva sample. These were used to investigate the intergenerational relationships between four epigenetic biomarkers (COMT, DRD2, GR, and SERT), trauma, and chronic pain. The results indicated that the significant biomarkers were dependent upon the gender of the child, wherein parental ACEs significantly correlated with changes in DRD2 expression in female children and altered COMT expression in the parents of male children. Additionally, the nature of the ACE (maltreatment vs. household dysfunction) was associated with the specific epigenetic changes. There may be different pathways through which parental ACEs confer risk for poor outcomes for males and females, highlighting the importance of child gender in future investigations.
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Affiliation(s)
- Jennaya Christensen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia;
| | - Jaimie K. Beveridge
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.B.); (M.N.)
| | - Melinda Wang
- Hotchkiss Brain Institute, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T2N 4N1, Canada
| | - Serena L. Orr
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.B.); (M.N.)
- Hotchkiss Brain Institute, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T2N 4N1, Canada
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia;
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.B.); (M.N.)
- Hotchkiss Brain Institute, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T2N 4N1, Canada
- Correspondence:
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The Role of Sleep in the Transition from Acute to Chronic Musculoskeletal Pain in Youth-A Narrative Review. CHILDREN-BASEL 2021; 8:children8030241. [PMID: 33804741 PMCID: PMC8003935 DOI: 10.3390/children8030241] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022]
Abstract
Musculoskeletal pain is common in the general pediatric population and is a challenge to youth, their parents, and society. The majority of children experiencing musculoskeletal pain will recover; however, a small subgroup of youth develops chronic pain. There is limited understanding of the factors that affect the transition from acute to chronic pain in youth. This review introduces sleep deficiency in the acute to chronic pain transition, exploring the potential mediational or mechanistic role and pathways of sleep in this process, including the interaction with sensory, psychological, and social components of pain and highlighting new avenues for treatment. Biological mechanisms include the increased production of inflammatory mediators and the effect on the hypothalamus-pituitary-adrenal (HPA) axis and on the dopaminergic signaling. Psychological and social components include the effect of sleep on the emotional-affective and behavioral components of pain, the negative impact on daily and social activities and coping strategies and on the reward system, increased pain catastrophizing, fear of pain, pain-related anxiety, hypervigilance, and social isolation. Future longitudinal studies are needed to elucidate these mechanistic pathways of the effect of sleep on the transition from acute to chronic pain, which may lead to the development of new treatment targets to prevent this transition.
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The Co-occurrence of Pediatric Chronic Pain and Depression: A Narrative Review and Conceptualization of Mutual Maintenance. Clin J Pain 2020; 35:633-643. [PMID: 31094934 DOI: 10.1097/ajp.0000000000000723] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Internalizing mental health issues co-occur with pediatric chronic pain at high rates and are linked to worse pain and functioning. Although the field has prioritized anxiety and posttraumatic stress disorder, little is known about co-occurring depression and chronic pain in youth, despite its high prevalence. The purpose of this narrative review was to examine the existing literature on the co-occurrence of pediatric chronic pain and depressive disorders and symptoms and propose a conceptual model of mutual maintenance to guide future research. METHODS The literature from both fields of pediatric pain and developmental psychology were searched to review the evidence for the co-occurrence of pediatric chronic pain and depression. Conceptual models of co-occurring mental health issues and chronic pain, as well as child depression, were reviewed. From both literatures, we provide evidence for a number of proposed child, parent, and neurobiological factors that may serve to mutually maintain both conditions over time. On the basis of this evidence, we propose a conceptual model of mutual maintenance and highlight several areas for future research in this area. RESULTS Evidence was found for the prevalence of depression in pediatric chronic pain as well as the co-occurrence of both conditions. The key mutually maintaining factors identified and proposed included neurobiological, intrapersonal (eg, cognitive biases, sleep disturbances, emotion regulation, and behavioral inactivation), and interpersonal (eg, parent mental health and pain, genes, and parenting) factors. DISCUSSION Given the dearth of research on mutual maintenance in this area, this review and conceptual model could drive future research in this area. We argue for the development of tailored treatments for this unique population of youth to improve outcomes.
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Whibley D, AlKandari N, Kristensen K, Barnish M, Rzewuska M, Druce KL, Tang NKY. Sleep and Pain: A Systematic Review of Studies of Mediation. Clin J Pain 2020; 35:544-558. [PMID: 30829737 PMCID: PMC6504189 DOI: 10.1097/ajp.0000000000000697] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives: A relationship between sleep and pain is well established. A better understanding of the mechanisms that link sleep and pain intensity is urgently needed to optimize pain management interventions. The objective of this systematic review was to identify, synthesize, and critically appraise studies that have investigated putative mediators on the path between sleep and pain intensity. Methods: A systematic search of 5 electronic bibliographic databases (EMBASE, MEDLINE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials) was conducted. Eligible studies had to apply a formal test of mediation to variables on the path between a sleep variable and pain intensity or vice versa. All searches, data extraction and quality assessment were conducted by at least 2 independent reviewers. Results: The search yielded 2839 unique articles, 9 of which were eligible. Of 13 mediation analyses, 11 investigated pathways from a sleep variable to pain intensity. Putative mediators included affect/mood, depression and/or anxiety, attention to pain, pain helplessness, stress, fatigue, and physical activity. Two analyses investigated pathways from pain intensity to a sleep variable, examining the potentially mediating role of depressive symptoms and mood. Although evidence supported a mediating role for psychological and physiological aspects of emotional experiences and attentional processes, methodological limitations were common, including use of cross-sectional data and minimal adjustment for potential confounders. Discussion: A growing body of research is applying mediation analysis to elucidate mechanistic pathways between sleep and pain intensity. Currently sparse evidence would be illuminated by more intensively collected longitudinal data and improvements in analysis.
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Affiliation(s)
- Daniel Whibley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition.,Aberdeen Centre for Arthritis and Musculoskeletal Health.,Department of Physical Medicine and Rehabilitation, Kratz Lab.,Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Nourah AlKandari
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition
| | - Kaja Kristensen
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition.,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Max Barnish
- Evidence Synthesis and Modelling for Health Improvement (ESMI), Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter
| | | | - Katie L Druce
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Whitney DG, Bell S, Whibley D, van der Slot WM, Hurvitz EA, Haapala H, Peterson MD, Warschausky SA. Effect of pain on mood affective disorders in adults with cerebral palsy. Dev Med Child Neurol 2020; 62:926-932. [PMID: 32388867 PMCID: PMC7955588 DOI: 10.1111/dmcn.14559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 12/13/2022]
Abstract
AIM To determine if pain is associated with 12-month incidence of mood affective disorders (MAD) in adults with cerebral palsy (CP). METHOD Data from Optum Clinformatics® Data Mart (2013-2016) were used for this retrospective cohort study. Diagnostic codes were used to identify adults (≥18y) with CP, incident cases of MAD, and covariates (other neurodevelopmental conditions, sleep disorders, arthritis). Pain (any type, location) was identified between 1st October 2014 and 30th September 2015. The pain group was divided into new or consistent pain if they had a history of pain (i.e. consistent) in the 12 months before their first pain claim date. Crude incidence rates of MAD (expressed per 100 person-years) were estimated. Cox regression was used to estimate hazard ratio (95% confidence interval [CI]) of MAD after adjusting for covariates. RESULTS Adults that had new pain (n=859; incidence rate=15.5) or consistent pain (n=1303; incidence rate=17.9) had greater crude incidence rate of MAD compared to adults without pain (n=3726; incidence rate=5.9). The elevated rate of MAD remained after adjusting for covariates, for new pain (hazard ratio=2.4; 95% CI=1.9-3.0) and consistent pain (hazard ratio=2.1; 95% CI=1.7-2.7). INTERPRETATION Pain is associated with greater incidence of MAD in adults with CP. This association remained after accounting for potential confounding factors. WHAT THIS PAPER ADDS What this paper adds Pain was associated with higher 12-month incidence of mood affective disorders (MAD). The 12-month MAD incidence was similar between new and consistent pain groups. The MAD incidence remained higher adjusting for neurodevelopmental comorbidities, sleep disorders, and arthritis.
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Affiliation(s)
- Daniel G. Whitney
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA,University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Sarah Bell
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Daniel Whibley
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA,University of Aberdeen, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Wilma M.A. van der Slot
- Rijndam Rehabilitation, Rotterdam, The Netherlands,Erasmus MC University Medical Center, Department of Rehabilitation Medicine, Rotterdam, The Netherlands
| | - Edward A. Hurvitz
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Heidi Haapala
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Mark D. Peterson
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA,University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Seth A. Warschausky
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
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Abstract
There is a complex interplay between sleep disturbance and patients in pain. There is an increasing appreciation of the direct effects of analgesic drugs and sleep quality. This review provides an overview of the effects of different analgesic drugs and their effects on phases of sleep. The effects of different pain conditions and their direct effects on sleep physiology are also discussed. A structured search of the scientific literature using MEDLINE and PubMed databases. Original human and animal studies were included. A multi-search term strategy was employed. An appreciation of the physiological effects of these drugs will allow a more considered prescription of them to better manage sleep disturbance.
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Affiliation(s)
- Adam Woo
- Consultant Anaesthetist & Pain Physician, King's College Hospital, London, UK
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Pate JW, Hancock MJ, Hush JM, Gray K, Pounder M, Pacey V. Prognostic factors for pain and functional disability in children and adolescents with persisting pain: A systematic review and meta-analysis. Eur J Pain 2020; 24:722-741. [PMID: 31997486 DOI: 10.1002/ejp.1539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to investigate prognostic factors for pain and functional disability in children and/or adolescents with persisting pain. DATABASES AND DATA TREATMENT To be included, studies had to be published, peer-reviewed prospective cohort studies of children and/or adolescents with persisting pain at baseline, that reported at least one baseline prognostic factor and its relationship with pain or functional disability at least 1 month after baseline. Two reviewers independently assessed study eligibility, completed data extraction and undertook quality assessment. Meta-analyses were performed when a prognostic factor was reported in two or more studies. RESULTS Of 10,992 studies identified from electronic database searches, 18 were included, investigating 62 potential prognostic factors. In clinical settings, insufficient data were available for meta-analysis. Some positive associations with pain and/or disability were reported by single studies for older age, baseline pain intensity and baseline functional disability across multiple combinations of follow-up times and outcomes. In community settings, meta-analyses of two studies found that prognostic factors for the ongoing presence of pain at medium-term (1-year) follow-up were older age (OR 1.25; 95% CI = 1.05-1.47), weekly day tiredness (OR 1.69; 95% CI = 1.14-2.51), weekly abdominal pain (OR 1.44; 95% CI = 1.03-2.02) and waking during the night (OR 1.49; 95% CI = 1.05-2.13). No studies in community settings reported on prognostic factors for functional disability. CONCLUSIONS Prognostic factors having significant associations with future pain and disability were identified; however, as few were investigated in more than one comparable study, the results need to be interpreted with caution. SIGNIFICANCE Prognostic factors from across the biopsychosocial spectrum are important to consider in paediatric pain clinical practice. However, most prognostic factors that experts have previously agreed upon have not been assessed in prospective cohort studies to date. The findings may help with prioritising data to collect during clinical assessments of children presenting with pain, in the context of pain and functional disability outcomes.
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Affiliation(s)
- Joshua W Pate
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Julia M Hush
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kelly Gray
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Meg Pounder
- Department of Pain Medicine, The Children's Hospital, Westmead, New South Wales, Australia
| | - Verity Pacey
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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29
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Sleep disturbance underlies the co-occurrence of trauma and pediatric chronic pain: a longitudinal examination. Pain 2020; 161:821-830. [DOI: 10.1097/j.pain.0000000000001769] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Scott AJ, Flowers O, Rowse G. A comparative study of the nature and magnitude of problems sleeping in inflammatory bowel disease (IBD) compared to healthy controls. PSYCHOL HEALTH MED 2020; 25:958-968. [DOI: 10.1080/13548506.2019.1707240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Alexander J. Scott
- The School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Olivia Flowers
- The School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Whitney DG, Warschausky SA, Whibley D, Kratz A, Murphy SL, Hurvitz EA, Peterson MD. Clinical factors associated with mood affective disorders among adults with cerebral palsy. Neurol Clin Pract 2019; 10:206-213. [PMID: 32642322 DOI: 10.1212/cpj.0000000000000721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/25/2019] [Indexed: 12/21/2022]
Abstract
Objective To determine individual and aggregated associations of cerebral palsy (CP)-related symptoms and the effect of comorbid neurodevelopmental conditions on mood (affective) disorders among adults with CP. Methods Cross-sectional data from 2016 were extracted from a random 20% sample of the Medicare fee-for-service database. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes were used to identify 18- to -64-year-old beneficiaries with CP, as well as mood (affective) disorders, pain, sleep disorders, fatigue, and comorbid neurodevelopmental conditions (intellectual disabilities [ID], autism spectrum disorders [ASD], and epilepsy). Results Four thousand eight hundred twenty-three of the 17,212 adults with CP had mood (affective) disorders (28.0%). After adjusting for age, sex, and race, pain (odds ratio [OR] = 2.15; 99.5% confidence interval [CI] = 1.94-2.39), sleep disorders (OR = 2.43; 99.5% CI = 2.13-2.77), fatigue (OR = 1.38; 99.5% CI = 1.18-1.60), ID (OR = 1.47; 99.5% CI = 1.31-1.63), ASD (OR = 1.44; 99.5% CI = 1.16-1.80), and epilepsy (OR = 0.81; 99.5% CI = 0.73-0.91) were each associated with mood (affective) disorders. When pain, sleep disorders, and fatigue were presented as a count variable, the adjusted odds of mood (affective) disorders increased with the number of factors: 1 factor (OR = 1.99; 99.5% CI = 1.79-2.22), 2 factors (OR = 4.18; 99.5% CI = 3.58-4.89), and all 3 factors (OR = 7.38; 99.5% CI = 5.17-10.53). Conclusions Among young and middle-aged adults with CP, mood (affective) disorders were associated with pain, sleep disorders, and fatigue, and increasing co-occurrence of these factors further increased the likelihood of mood (affective) disorders. Further, comorbid neurodevelopmental conditions were also associated with mood (affective) disorders among adults with CP. Study findings could be used to improve screening strategies for mood (affective) disorders among adults with CP in the clinical setting.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Seth A Warschausky
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Anna Kratz
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Susan L Murphy
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
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Yoon IA, Sturgeon JA, Feinstein AB, Bhandari RP. The role of fatigue in functional outcomes for youth with chronic pain. Eur J Pain 2019; 23:1548-1562. [DOI: 10.1002/ejp.1431] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 05/11/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Isabel Angela Yoon
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine, Stanford/Lucile Packard Pediatric Pain Management Clinic Menlo Park California
| | - John Andrew Sturgeon
- Department of Anesthesiology and Pain Medicine University of Washington School of Medicine, Center for Pain Relief Seattle Washington
| | - Amanda Beth Feinstein
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine, Stanford/Lucile Packard Pediatric Pain Management Clinic Menlo Park California
| | - Rashmi Parekh Bhandari
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine, Stanford/Lucile Packard Pediatric Pain Management Clinic Menlo Park California
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Deacy AD, Friesen CA, Staggs VS, Schurman JV. Evaluation of clinical outcomes in an interdisciplinary abdominal pain clinic: A retrospective, exploratory review. World J Gastroenterol 2019; 25:3079-3090. [PMID: 31293343 PMCID: PMC6603811 DOI: 10.3748/wjg.v25.i24.3079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pediatric functional gastrointestinal disorders (FGIDs) are common and well-accepted to be etiologically complex in terms of the contribution of biological, psychological, and social factors to symptom presentations. Nonetheless, despite its documented benefits, interdisciplinary treatment, designed to address all of these factors, for pediatric FGIDs remains rare. The current study hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic (APC) would demonstrate clinical resolution of symptoms during the study period and that specific psychosocial variables would be significantly predictive of GI symptom improvement. AIM To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIDs and identify patient characteristics that predicted clinical outcomes. METHODS Participants were 392 children, ages 8-18 [M = 13.8; standard deviation (SD) = 2.7], seen between August 1, 2013 and June 15, 2016 in an interdisciplinary APC housed within the Division of Gastroenterology in a medium-sized Midwestern children's hospital. To be eligible, patients had to be 8 years of age or older and have had abdominal pain for ≥ 8 wk at the time of initial evaluation. Medical and psychosocial data collected as part of standard of care were retrospectively reviewed and analyzed in the context of the observational study. Logistic regression was used to model odds of reporting vs never reporting improvement, as well as to differentiate rapid from slower improvers. RESULTS Nearly 70% of patients followed during the study period achieved resolution on at least one of the employed outcome indices. Among those who achieved resolution during follow up, 43% to 49% did so by the first follow up (i.e., within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment). Patient age, sleep, ease of relaxation, and depression all significantly predicted the likelihood of resolution. More specifically, the odds of clinical resolution were 14% to 16% lower per additional year of patient age (P < 0.001 to P = 0.016). The odds of resolution were 28% to 42% lower per 1-standard deviation (SD) increase on a pediatric sleep measure (P = 0.006 to P < 0.040). Additionally, odds of clinical resolution were 58% lower per 1-SD increase on parent-reported measure of depression (P = 0.006), and doubled in cases where parents agreed that their children found it easy to relax (P = 0.045). Furthermore, sleep predicted the rapidity of clinical resolution; that is, the odds of achieving resolution by the first follow up visit were 47% to 60% lower per 1-SD increase on the pediatric sleep measure (P = 0.002). CONCLUSION Outcomes for youth with FGIDs may be significantly improved by paying specific attention to sleep, ensuring adequate skills for relaxation, and screening of and referral for treatment of comorbid depression.
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Affiliation(s)
- Amanda D Deacy
- Division of Gastroenterology, Children’s Mercy Kansas City; UMKC School of Medicine, Kansas City, MO 64108, United States
- Division of Developmental and Behavioral Sciences, Children’s Mercy Kansas City; UMKC School of Medicine, Kansas City, MO 64108, United States
| | - Craig A Friesen
- Division of Gastroenterology, Children’s Mercy Kansas City; UMKC School of Medicine, Kansas City, MO 64108, United States
| | - Vincent S Staggs
- Biostatistics and Epidemiology, Health Services and Outcomes Research, Children’s Mercy Kansas City; UMKC School of Medicine, Kansas City, MO 64108, United States
| | - Jennifer V Schurman
- Division of Gastroenterology, Children’s Mercy Kansas City; UMKC School of Medicine, Kansas City, MO 64108, United States
- Division of Developmental and Behavioral Sciences, Children’s Mercy Kansas City; UMKC School of Medicine, Kansas City, MO 64108, United States
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Aaron R, Noel M, Dudeney J, Wilson A, Holley A, Palermo T. The role of sleep quality on the relationship between posttraumatic stress symptoms and pain in women. J Behav Med 2019; 42:924-933. [PMID: 30762157 DOI: 10.1007/s10865-019-00016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/30/2019] [Indexed: 12/25/2022]
Abstract
Pain frequently co-occurs with elevated posttraumatic stress symptoms (PTSS); women are at elevated risk for their co-occurrence. PTSS and pain are associated with poor sleep quality; yet, little research has examined how sleep impacts their co-occurrence. The current study examines the indirect role of sleep on the relationship between PTSS and pain. A community sample of 182 women completed psychometrically-sound questionnaires assessing PTSS, sleep quality, pain characteristics, depression and anxiety symptoms, and anxiety sensitivity. We examined how sleep quality impacted associations among PTSS and pain intensity and pain interference, while controlling for key psychological factors. Greater PTSS was associated with worse pain interference, and poor sleep quality had a significant indirect effect on this relationship. Sleep may represent a modifiable behavioral mechanism that contributes to the mutual maintenance of PTSS and pain in women. Future research is needed to further clarify the role of sleep quality in their co-occurrence.
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Affiliation(s)
- Rachel Aaron
- Seattle Children's Research Institute, University of Washington, Seattle, USA. .,Johns Hopkins Medicine, 1800 Orleans St., Baltimore, MD, 21287, USA.
| | - Melanie Noel
- Alberta Children's Hospital and Research Institute, University of Calgary, Calgary, Canada
| | - Joanne Dudeney
- Seattle Children's Research Institute, University of Washington, Seattle, USA
| | - Anna Wilson
- Oregon Health & Science University, Portland, USA
| | - Amy Holley
- Oregon Health & Science University, Portland, USA
| | - Tonya Palermo
- Seattle Children's Research Institute, University of Washington, Seattle, USA
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Christensen J, Noel M, Mychasiuk R. Neurobiological mechanisms underlying the sleep-pain relationship in adolescence: A review. Neurosci Biobehav Rev 2019; 96:401-413. [PMID: 30621863 DOI: 10.1016/j.neubiorev.2018.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/20/2022]
Abstract
Adolescence characterizes a period of significant change in brain structure and function, causing the neural circuitry to be particularly susceptible to the environment and various other experiences. Chronic pain and sleep deprivation represent major health issues that plague adolescence. A bidirectional relationship exists between sleep and pain; however, emerging evidence suggests that sleep disturbances have a stronger influence on subsequent pain than vice versa. The neurobiological underpinnings of this relationship, particularly during adolescence, are poorly understood. This review examines the current literature regarding sleep and pain in adolescence, with a particular focus on the neurobiological mechanisms underlying pain, sleep problems, and the neural circuitry that potentially links the two. Finally, a research agenda is outlined to stimulate future research on this topic. Given the high prevalence of these health issues during adolescence and the debilitating effects they inflict on nearly every domain of development, it is crucial that we determine the neurobiological mechanisms fundamental to this relationship and identify potential therapeutic strategies.
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Affiliation(s)
- Jennaya Christensen
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Hotchkiss Brain Institute, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Hotchkiss Brain Institute, Canada
| | - Richelle Mychasiuk
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Hotchkiss Brain Institute, Canada.
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