The Relationship Between Sleep, Chronic Pain, and Mood Disorders in Children

The presence of sleep disorders in children with chronic pain may result in greater pain levels and pain interference, a relationship that may in part be mediated by anxiety and depressive symptoms, according to a study published in Pain Research and Management.

Youth with primary pain disorders often experience a combination of sleep difficulties, chronic pain and depressive/anxiety symptoms. Recent evidence suggests that impaired sleep may precede chronic pain, mood, and anxiety.

A total of 147 children (66.7% girls; mean age, 13.32; mean pain duration, 35.17 months) between age 8 and 18 were enrolled in this study. The participants were evaluated at a chronic pain program in a tertiary setting. The majority of patients (62.6%) presented with multiple pain locations and 43.5% of study participants reported constant pain.

At baseline, all participants self-reported sleep quality, pain intensity, pain interference, and anxiety and depression. Anxiety (P =.030), sleep quality (P =.028), and pain interference (P =.003) were all worse in girls vs boys, and higher levels of depressive symptoms correlated with older age (r = 0.29; P <.001).

Reduced sleep quality was correlated with increased anxiety (r = −0.40; P < .001), depression (r = −0.39; P < .001), pain intensity (r = −0.20; P = .016) and pain interference (r = −0.43; P < .001). Elevated anxiety was associated with greater pain intensity (r = 0.27; P = .001), pain interference (r = 0.48; P < .001), and anxiety and depressive symptoms (r = 0.27; P =.001 and r = 0.22; P =.008, respectively).

Study limitations included an inability to make inferences about the directionality of the relationship between variables and limited generalizability to more diverse populations.

“Our findings emphasize the importance of addressing internalizing mental health symptoms and sleep impairments in the treatment of pediatric chronic pain [patients] given their negative influence on pain outcomes,” concluded the study authors. “Although sleep hygiene is sometimes included in cognitive-behaviour therapy interventions for chronic pain, mental health issues are often not formally addressed,” they added.

This work was supported by funding awarded to Dr Noel by the Vi Riddell Pediatric Pain Initiative and the Alberta Children’s Hospital Foundation.

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Reference

Pavlova M, Ference J, Hancock M, Noel M. Disentangling the sleep-pain relationship in pediatric chronic pain: the mediating role of internalizing mental health symptoms. Pain Res Manag. 2017;2017:1-9. doi:10.1155/2017/1586921