Insomnia in youth with chronic pain: a longitudinal study

Abstract

Adolescents with chronic pain frequently report difficulties falling and staying asleep. It is unknown whether these difficulties are transient or whether they persist over time. This study aimed to 1) examine trajectories of insomnia symptoms over one year in adolescents with chronic pain compared to their healthy peers; 2) evaluate depression, sleep hygiene, pre-sleep arousal (worries and somatic sensations at bedtime), and pain intensity as risk factors for chronic insomnia; and 3) evaluate chronic insomnia as a predictor of longitudinal quality of life and activity limitations outcomes. Sixty-one adolescents from a pain clinic were compared to 60 youth from the community (mean age = 15.07; 73% female). Participants completed measures of depressive symptoms, sleep hygiene, sleep quality, pain intensity, activity limitations, and quality of life at enrollment, and 6-month and 12-month follow-ups. Longitudinal analyses indicated that youth with chronic pain were significantly more likely to report insomnia symptoms at each data wave compared to their healthy peers (p < 0.001). Insomnia symptoms were relatively stable for both groups with no significant changes across the 1-year period. Generalized estimating equation (GEE) modeling identified three risk factors for chronic insomnia: having chronic pain (β = 1.52, p <0.001), higher depressive symptoms (β = 0.05, p = 0.03), and poorer sleep hygiene (β = -0.98, p = 0.003). Longitudinal analyses controlling for group status (pain vs. healthy), pain intensity, and depressive symptoms demonstrated that chronic insomnia symptoms predicted lower quality of life (β = -0.81, p < 0.01) and greater activity limitations (β = 0.58, p < 0.05). These findings indicate that insomnia symptoms tend to persist over time, suggesting that youth with chronic pain may benefit from targeted sleep treatment. Research is needed to determine the optimal timing of pain and sleep interventions for youth with comorbid chronic pain and insomnia.