(116) Assessment of anxiety as mediator of the relationship between sleep disturbance and pain catastrophizing in chronic pain

Abstract

One of the most commonly reported issues of chronic pain sufferers is sleep disturbance, which causes decreases in productivity and quality of life for 70-88% of the chronic pain population.3 These patients also often suffer from anxiety and pain catastrophizing (PC), a negative emotional and cognitive state regarding actual or anticipated pain; however, it is unclear how these psychological conditions contribute to their disrupted sleep. Thus, we conducted the largest known retrospective review of sleep disturbance, anxiety, and PC scores using the Stanford-NIH Collaborative Health Outcomes Measurement Information Registry (CHOIR),1 including measures from the Patient Reported Outcomes Measurement Information System (PROMIS). Data were obtained for 637 chronic pain patients who were seeking new medical evaluation at a tertiary pain clinic (390 females, 247 males, mean age=48.8). Anxiety is known to highly correlate with PC4 and with sleep disturbance2 thus, we hypothesized a significant relationship between patients’ sleep disturbance and PC scores and that anxiety would specifically mediate this relationship because psychological and physiological responses to anxiety are known to disrupt sleep. Univariate analysis showed a significant direct relationship between sleep disturbance scores and PC scores (p<.001). Anxiety was also independently and significantly correlated to sleep disturbance (p<.001). We conducted multivariate modeling with anxiety and PC scores as predictors for sleep disturbance, controlling for average pain intensity. The overall model was highly significant (p<.001) and PC scores became insignificant, suggesting complete mediation from anxiety. These results elucidate the important role of anxiety in sleep disturbance and have implications for research and treatment of sleep disturbance in chronic pain populations. (1. Kao et al. J Pain, 2014; 2. Monti et al. Sleep Med Rev, 2000; 3. Smith. Sleep Med Rev, 2004; 4. Sullivan et al. Psychol Assessment, 1995.) Funding: NIH NIDA (K24 DA029262 Neuroimaging and Mentoring in Translational Pain Research). One of the most commonly reported issues of chronic pain sufferers is sleep disturbance, which causes decreases in productivity and quality of life for 70-88% of the chronic pain population.3 These patients also often suffer from anxiety and pain catastrophizing (PC), a negative emotional and cognitive state regarding actual or anticipated pain; however, it is unclear how these psychological conditions contribute to their disrupted sleep. Thus, we conducted the largest known retrospective review of sleep disturbance, anxiety, and PC scores using the Stanford-NIH Collaborative Health Outcomes Measurement Information Registry (CHOIR),1 including measures from the Patient Reported Outcomes Measurement Information System (PROMIS). Data were obtained for 637 chronic pain patients who were seeking new medical evaluation at a tertiary pain clinic (390 females, 247 males, mean age=48.8). Anxiety is known to highly correlate with PC4 and with sleep disturbance2 thus, we hypothesized a significant relationship between patients’ sleep disturbance and PC scores and that anxiety would specifically mediate this relationship because psychological and physiological responses to anxiety are known to disrupt sleep. Univariate analysis showed a significant direct relationship between sleep disturbance scores and PC scores (p<.001). Anxiety was also independently and significantly correlated to sleep disturbance (p<.001). We conducted multivariate modeling with anxiety and PC scores as predictors for sleep disturbance, controlling for average pain intensity. The overall model was highly significant (p<.001) and PC scores became insignificant, suggesting complete mediation from anxiety. These results elucidate the important role of anxiety in sleep disturbance and have implications for research and treatment of sleep disturbance in chronic pain populations. (1. Kao et al. J Pain, 2014; 2. Monti et al. Sleep Med Rev, 2000; 3. Smith. Sleep Med Rev, 2004; 4. Sullivan et al. Psychol Assessment, 1995.) Funding: NIH NIDA (K24 DA029262 Neuroimaging and Mentoring in Translational Pain Research).