Next-day Pain Research Articles

Night time heart rate predicts next-day pain in fibromyalgia and primary back pain.

Primary chronic pain is pain that persists for over 3 months without associated measurable tissue damage. One of the most consistent findings in primary chronic pain is its association with autonomic hyperactivation. Yet whether the autonomic hyperactivation causes the pain or results from it is still unclear. It is also unclear to what extent autonomic hyperactivation is related to experienced pain intensity in different subtypes or primary chronic pain. Our first aim was to test lagged relationships between the markers of autonomic activation (heart rate) and pain intensity to determine its directionality. The main question here was whether autonomic biomarkers predict pain intensity or whether pain intensity predicts autonomic biomarkers. The second aim was to test whether this relationship is different between people with primary back pain and people with fibromyalgia. Sixty-six patients with chronic pain were observed over an average of 81 days. Sleep heart rate and heart rate variability were measured with a wearable sensor, and pain intensity was assessed from daily subjective reports. The results showed a predictive relationship between sleep heart rate and next-day pain intensity (P < 0.05), but not between daily pain intensity and next night heart rate. There was no interaction with the type of chronic pain. These findings suggest that autonomic hyperactivation, whether stress-driven or arising from other causes, precedes increases in primary chronic pain. Moreover, the present results suggest that autonomic hyperactivation is a common mechanism underlying the pain experience in fibromyalgia and chronic back pain.

Mapping the associations of daily pain, sleep, and psychological distress in a U.S. sample.

Chronic pain, sleep problems, and psychological distress (PD) can be disabling conditions and previous research has shown that they are associated. The nuances of the comorbid nature of these conditions may be important to understand for those who treat these conditions. This study examined the bidirectional associations of these health factors concurrently and over time in a sample of U.S. adults (N = 1,008, Mage = 57.68) from the Midlife in the United States (MIDUS) study. Participants reported on their daily pain, sleep quantity, and psychological distress over eight days. A modified Random Intercept Cross-lagged Panel Model was used to analyze the relations, starting with the whole sample and then a comparison of those with and without chronic pain. Results indicated that nightly variation in sleep quantity predicted next day psychological distress for both groups. Sleep quantity also predicted next-day pain, but only for individuals with chronic pain. Associations between pain and psychological distress were found both at the daily level and individual (between-person) level. This between-person association was stronger for those with chronic pain. The lagged associations between sleep, and both pain and psychological distress for the chronic pain group indicate that, increased quantity of sleep predicts decreased next-day pain and psychological distress. Providers could consider this unidirectional lagged relationship when prioritizing treatment for patients with these comorbid conditions. Future research may examine whether responsive, just-in-time treatments might intervene after participants wake from a poor night's sleep to counteract the negative effects of reduced sleep on PD and pain.

Sleep-EEG Spectral Power Predicts Next-Day Pain In Long-Term Opioid Users With Chronic Low-Back Pain

Sleep-EEG Spectral Power Predicts Next-Day Pain In Long-Term Opioid Users With Chronic Low-Back Pain

Nocturnal Delta Power is Associated With Lower Next-Day Pain But Not Pain Catastrophizing: Results From a Cohort of Female Participants With Temporomandibular Joint Pain

Existing data demonstrate reduced delta power during sleep in patients with depression and chronic pain. However, there has been little examination of the relationship between delta power and pain-reports, or pain-catastrophizing. We recruited female participants (n = 111) with insomnia and temporomandibular disorder, and measured nocturnal and daytime measures of pain and pain catastrophizing, and calculated relative nocturnal delta (0.5–4 Hz) power during sleep. We fit linear regression models, and further examined the moderating effect of depressive symptom severity. Lower relative delta power across the whole night was significantly associated with greater nocturnal pain (B = -20.276, P = .025, R2 = 0.214). Lower relative delta power during the first-third of the night, was associated with greater nocturnal pain (B = -17.807, p = 0.019, R2 = 0.217), next-day pain (B = 13.876, P = .039, R2 = 0.195), and next-morning pain (B = -15.751, P = .022, R2 = 0.198). Lower relative delta power during the final-third of the night was significantly associated with greater nocturnal (B = -17.602, P = .029, R2 = 0.207) and next-morning pain (3rd: B = -14.943, P = .042, R2 = 0.187). Depressive symptom severity did not moderate these relationships. Delta power was not significantly associated with nocturnal or daytime pain catastrophizing. These findings demonstrate that greater relative delta power during sleep is associated with lower nocturnal and next-day pain in patients with temporomandibular disorder. This data may guide the use of sleep interventions in clinical pain populations, with the aim of improving pain outcomes. PerspectiveThis article presents data demonstrating an association between increased nocturnal delta power and reduced next-day pain. These findings may help promote interventions which aim to increase nocturnal delta power in clinical pain populations, with the goal of improving pain outcomes.

Frequency of Nocturnal Awakenings Moderates the Relationship between Daily Positive Affect and Pain among Patients with Sickle Cell Disease

Experimental forced nocturnal awakenings increases next-day pain sensitivity and attenuates the degree to which affect modulates pain in healthy individuals. Naturalistic measures of sleep disruption have also linked to pain in patients with sickle cell disease. The aims of the present analysis were to examine interactions between nightly indices of naturalistic sleep disruption (nocturnal awakenings and minutes of wake after sleep onset(WASO)) and interactions between daily positive affect (PA) or negative affect (NA) and pain in patients with sickle cell disease. Individuals with sickle cell disease and daily pain (N=25, Mage=42.0) completed daily sleep diaries and reports of pain, PA, NA, and prescription opioid use. A total of 366 days were included in the analysis (M per participant=14.64). We examined whether sleep disruption variables moderated the relationship between affective variables (daily PA or NA) and pain using mixed models. Simple-slopes analyses were used to probe significant interactions. All models controlled for person-level opioid morphine milligram equivalents (MME, M=81.30). Daily PA (Bs> -0.16, ps<.002) and NA (Bs> 0.28, ps<.001) were associated with daily pain. Number of previous night awakenings moderated the effect of PA on daily pain (B=-0.15, p=.002), such that the association of low PA with elevated daily pain was stronger when nocturnal awakenings were more frequent. Awakenings did not moderate the effect of NA on pain. WASO predicted next-day pain in the PA model (B=0.004, p=.022), but not the NA model (p=.053), and did not interact with PA or NA to predict pain. These findings demonstrate that the elevation in pain observed under conditions of low PA is amplified following nights of disrupted sleep. This naturalistic study extends results from experimental studies to daily life and suggests that the effects of sleep, affect, and pain are better characterized through their interactions than their individual associations. Grant support from NINDS 3U54EB020404-05S1 JDE: NIDA T32DA007209, (PI = E. Stain, E. Weerts, G. Bigelow) CH, MS: NINDS T32NS070201, (PI = M. Smith). Experimental forced nocturnal awakenings increases next-day pain sensitivity and attenuates the degree to which affect modulates pain in healthy individuals. Naturalistic measures of sleep disruption have also linked to pain in patients with sickle cell disease. The aims of the present analysis were to examine interactions between nightly indices of naturalistic sleep disruption (nocturnal awakenings and minutes of wake after sleep onset(WASO)) and interactions between daily positive affect (PA) or negative affect (NA) and pain in patients with sickle cell disease. Individuals with sickle cell disease and daily pain (N=25, Mage=42.0) completed daily sleep diaries and reports of pain, PA, NA, and prescription opioid use. A total of 366 days were included in the analysis (M per participant=14.64). We examined whether sleep disruption variables moderated the relationship between affective variables (daily PA or NA) and pain using mixed models. Simple-slopes analyses were used to probe significant interactions. All models controlled for person-level opioid morphine milligram equivalents (MME, M=81.30). Daily PA (Bs> -0.16, ps<.002) and NA (Bs> 0.28, ps<.001) were associated with daily pain. Number of previous night awakenings moderated the effect of PA on daily pain (B=-0.15, p=.002), such that the association of low PA with elevated daily pain was stronger when nocturnal awakenings were more frequent. Awakenings did not moderate the effect of NA on pain. WASO predicted next-day pain in the PA model (B=0.004, p=.022), but not the NA model (p=.053), and did not interact with PA or NA to predict pain. These findings demonstrate that the elevation in pain observed under conditions of low PA is amplified following nights of disrupted sleep. This naturalistic study extends results from experimental studies to daily life and suggests that the effects of sleep, affect, and pain are better characterized through their interactions than their individual associations. Grant support from NINDS 3U54EB020404-05S1 JDE: NIDA T32DA007209, (PI = E. Stain, E. Weerts, G. Bigelow) CH, MS: NINDS T32NS070201, (PI = M. Smith).

Prior Night Sleep Affects Next-Day Pain Interference Among Community-Dwelling Older Adults With Lower Extremity Chronic Pain.

Emergent work suggests that sleep is a robust biobehavioral predictor of pain; however, it remains unclear how sleep is prospectively linked to pain on a day-to-day basis among older adults. The current prospective study examined how sleep duration (total sleep time), quality (sleep efficiency, wake after sleep onset), and late and irregular sleep timing influenced next-day pain perception among community-dwelling older adults (N = 10; 65 matched observations) with lower extremity chronic pain over 1 week. Multilevel modeling estimated the association between sleep (Actigraph GT9X Link) and pain perception (Brief Pain Inventory Short Form). Increased wake after sleep onset (B = 0.19, p = 0.04), sleep variability (B = 0.02, p = 0.01), and later midsleep time (B = 0.40, p < 0.05) were associated with increased pain interference the following day. Findings support the idea that timely sleep interventions may reduce the effect of poor sleep on next-day pain in older adults. [Research in Gerontological Nursing, 14(4), 173-179.].

Sleep and Injury Risk.

Sleep has been found to have wide-ranging effects on sports performance and overall well-being. Recent research has found evidence relating chronic suboptimal sleep with the risk of musculoskeletal pain and sports injury. The amount of sleep that consistently has been found to be associated with increased risk of injury is ≤7 h of sleep, which when sustained for periods of at least 14 d has been associated with 1.7 times greater risk of musculoskeletal injury. However, it is unknown if sleep loss predisposes the athlete to specific types of musculoskeletal injuries. The role of sleep on musculoskeletal pain is important to understand as studies in both children and adults have found that suboptimal sleep more consistently predicts next-day pain as compared with pain predicting subsequent sleep loss. Despite the evidence that certain aspects of sleep behavior seem to increase the risk of musculoskeletal injury and pain, sleep should be considered as only a part of the athlete's overall health and well-being when assessing the athlete for risk of injury.

587 Temporal Daily Relationships Between Sleep Deficiency and Pain in Youth with Systemic Lupus Erythematosus

Abstract Introduction Systemic Lupus Erythematosus (SLE) is a chronic, inflammatory autoimmune disorder characterized by recurrent episodes of pain and is more prevalent in youth of color. Although sleep deficiency (poor quality and an inadequate amount of sleep) and pain are interrelated, most of what is known about SLE pain and sleep rely on reports from adults. Less is known about these associations in youth with SLE, leaving a critical gap in care for this population. This study aims to describe the temporal daily relationships between sleep deficiency and pain in 11-to 18-year-old youth with SLE. Methods Twenty-three youth (n=21 girls, n=9 Hispanic) with SLE (mean age=14.7 □ 2.2) participated in the study. Youth wore actigraphy and completed electronic sleep diaries for consecutive 10 days. Actigraphic sleep variables (Total Sleep Time [TST], Sleep Efficiency [SE]) and self-reported Sleep Quality (diary SQ) were examined as predictors of next-day pain in the morning. Average daytime pain was examined as a predictor of nighttime sleep (both actigraphic and self-reported sleep variables). Pubertal stage and ethnicity (Hispanic vs. Non-Hispanic) were entered as covariates in all models. Results Of the sample, the mean TST was 7 □ 1.2 hours and the mean SE was 73.5 □ 9.2% as measured by actigraphy. On average, diary SQ negatively predicted next-day pain in the morning (p &amp;lt;.001). On average, pain negatively predicted TST (p &amp;lt;.05) and diary SQ (p &amp;lt;.001). The within-subject relationships between sleep and next-day pain were not significant. Daytime pain predicted neither actigraphic nor self-reported sleep quality. Conclusion Poor sleep is a modifiable behavior, and improving sleep quality may reduce pain intensity in youth with SLE. Although further study is needed, the findings suggest that sleep is a potential target for interventions to alleviate symptoms of pain in this population. Support (if any) This work was funded by NIH/NINR P30NR016585 (MPI: MMH, TMW), R21NR017471 (TMW); University of Washington, School of Nursing, Research and Intramural Funding (RIFP); Hester McLaws Nursing Scholarship.

Daily associations between sleep and pain in patients with chronic musculoskeletal pain.

Patients with chronic pain commonly report sleep problems, and the evidence for a relationship between sleep disturbance and pain seems robust. The day-to-day associations between these constructs are less well studied, particularly with objective sleep measures such as actigraphy. Moreover, the concurrent presence of negative affective symptoms, as well as seasonality effects at extreme latitudes may complicate it further. Here, we studied 56 patients with chronic primary musculoskeletal pain conditions, contributing data in two separate 7-day data-collection periods during the summer and winter, respectively. The effect of self-reported sleep quality, and actigraphy measured sleep duration, efficiency and timing on next-day pain, as well as the effect of pain on the same sleep indices were estimated by generalised linear mixed regression models. The models were additionally adjusted for age, sex, education, data collection period, weekend, season and mental distress, with the latter two also specified as moderators. We observed a significant effect of pain as a predictor of next-night sleep quality (p=.003) and marginally of next-night sleep duration (p=.079). Conversely, sleep quality tentatively predicted next-day pain (p=.063). No other day-to-day associations were present. Mental distress was the strongest predictor of pain, but it did not modify the sleep-pain associations, nor did season. In conclusion pain, sleep quality and mental distress are closely related, underscoring the importance of encompassing this complexity in assessment and treatment of patients with chronic pain.

Poor Sleep Increases Next Day Pain, Particularly for Older Adults With Mild Cognitive Impairment

Sleep studies examine how pain is associated with poor sleep. However, emergent research suggests poor sleep increases pain and may interfere with activities of daily living (ADL) among older adults. This study will examine how poor sleep may affect next-day pain interference and how this relationship may vary by cognitive function. Ten community-dwelling older adults with lower extremity chronic pain wore an Actigraph GT9X Link for 7 days to measure poor sleep and next-day pain interference (Brief Pain Inventory; BPI). Multi-level mixed models accounted for intra-individual changes in sleep and pain interference and controlled for age, mild cognitive impairment (MCI) and depressive symptoms. Poor sleep among older adults with MCI (14 total observations) was also explored. Across 79 observations, increased number of awakenings (β=0.03; p≤ 0.05) and movement index scores (β=0.08; p≤ 0.05) were associated with increased next-day pain interference. In exploratory analyses, MCI intensified relationships between sleep efficiency (β=-0.10; p≤ 0.05), increased awakenings after sleep onset (β=0.01; p≤ 0.05) and increased length of sleep awakenings (β=0.39; p≤ 0.01) on next-day pain interference. This study’s findings suggest poor sleep is associated with next-day pain interference and the ability to perform ADL. Older adults with MCI may be at an increased risk for poor sleep and pain-related interference in ADL. Interventions designed to moderate the association between poor sleep and pain in general and for adults with MCI in particular may be warranted.

1011 Sleep Duration Moderates the Association Between Next-Day Physical Activity and Pain Intensity Among Women with Fibromyalgia

Abstract Introduction Suboptimal sleep has been consistently associated with greater next-day pain intensity among women with fibromyalgia. In contrast, associations between physical activity and same-day pain in this population are contradictory. Given this inconsistency, we aimed to determine whether the daily physical activity-pain association is modified by sleep parameters. Methods This micro-longitudinal study used data collected using wrist-worn triaxial accelerometers over seven consecutive days by 44 adult women with fibromyalgia. Derived variables included sleep duration, sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE) and maximum daily physical activity count. Participants also completed digital diaries of refreshed sleep upon awakening (scale 0-100), and pain intensity (5x/day, scale 0-100). Multilevel linear regression models with interaction terms were used to investigate moderating effects of sleep on the next-day person-centered maximum physical activity-average pain intensity association. Results The sample mean age was 44 (SD 14). A total of 304 days of data were available for analysis. Mean sleep duration was 471min(SD 66); mean SOL 10min(SD 10); mean WASO 31min(SD 17), and mean SE 90%(SD 5). Sleep duration moderated the next-day maximum physical activity-pain association (Wald statistic p=0.01). After nights of both shorter (&amp;lt;7 hours) and longer sleep (&amp;gt;8 hours), higher levels of next-day maximum physical activity (compared to the participant’s overall study average) were associated with days of greater average pain. In contrast, after nights of 7-8 hours of sleep, higher levels of next-day maximum physical activity were associated with days of lower average pain. Conclusion An association between higher maximum physical activity and lower levels of pain was only observed after nights of 7-8 hours sleep. Engaging in physical activity is recommended for fibromyalgia-related pain management. Optimizing sleep duration may be useful in minimizing physical activity-related pain in this clinical population. Support DW is supported by a Foundation Fellowship Versus Arthritis. The study that provided data was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award number K01AR064275;PI:ALK). The Michigan Institute for Clinical &amp; Health Research provided subject recruitment support through the UMHealthResearch.org website (MICHR:NIH award number UL1TR002240).

Relationships Between Abdominal Pain and Fatigue With Psychological Distress as a Mediator in Women With Irritable Bowel Syndrome.

Women with irritable bowel syndrome often report fatigue, along with abdominal pain and psychological distress (i.e., depression and anxiety). There is little information about the relationships among these symptoms. Using a secondary data analysis (N = 356), we examined the relationship between abdominal pain and fatigue and whether psychological distress mediates the effect of abdominal pain on fatigue in both across women and within woman with irritable bowel syndrome. Data gathered through a 28-day diary were analyzed with linear regressions. The across-women and within-woman relationships among same-day abdominal pain, fatigue, and psychological distress were examined. Within-woman relationships were also examined for directionality among symptoms (i.e., prior-day abdominal pain predicts next-day fatigue and prior-day fatigue predicts next-day abdominal pain). In across-women and within-woman analyses on the same day, abdominal pain and fatigue were positively correlated. In within-woman analyses, abdominal pain predicted next-day fatigue, but fatigue did not predict next-day pain. In across-women and within-woman analyses, psychological distress partially mediated the effects of abdominal pain on fatigue. Symptom management incorporating strategies to decrease both abdominal pain and psychological distress are likely to reduce fatigue. Nursing interventions, such as self-management skills to reduce abdominal pain and psychological distress, may have the added benefit of reducing fatigue in irritable bowel syndrome.

Transient Effects of Sleep on Next-Day Pain and Fatigue in Older Adults With Symptomatic Osteoarthritis

Poor sleep quality has been associated with greater pain and fatigue in people living with osteoarthritis (OA). The objective of this micro-longitudinal study was to determine whether sleep impacts the diurnal pattern of next-day OA-related pain and fatigue. Community-dwelling older adults (≥65 years) with hip and/or knee OA provided data over 5 days using daily diaries and wrist-worn actigraphs. Pain and fatigue intensity were measured on awakening, at 11 am, 3 pm, 7 pm, and bedtime. Subjective previous night sleep quality was measured on awakening. Multilevel linear regression models examined interactions between sleep variables and time of next-day symptom reports. One hundred sixty participants provided 785 days of data (median age = 71 years; 62% female). Analysis of time interaction effects identified an association between poor sleep quality and more morning pain and fatigue. Although the effect on awakening was more pronounced for fatigue, differences in both symptoms attributable to sleep quality attenuated as the day progressed. Investigation of actigraphy-based sleep parameters revealed no significant interactions with time of symptom measurement. These findings observed in a sample of older adults with mild-to-moderate OA symptoms warrant further investigation in a sample with more severe symptoms and more pronounced sleep dysfunction and/or sleep disorders. PerspectiveThis article investigates the impact of sleep on next-day pain and fatigue of older adults with OA. On awakening from a night of poor quality sleep, pain and fatigue intensity were heightened. However, the effect was not sustained throughout the day, suggesting the morning may be an optimal time for symptom interventions.

Longer Sleep Duration and Later Sleep Timing are Associated with Increased Cold-Pain Perception During the Day

Experimental studies on the associations between sleep and evoked pain in healthy individuals have generally demonstrated increased pain sensitivity following sleep deprivation, yet few have addressed the association between habitual sleep patterns and next-day pain sensitivity. This study aimed to assess relationships between habitual sleep quantity, quality, and timing based on objective measurement of sleep (actigraphy) and experimentally evoked cold-pain perception during the day in healthy young men. Forty-eight healthy, young male participants without pain or sleep disturbance were examined via cold pressor test to obtain measures of cold-pain threshold, tolerance, and intensity in the morning, afternoon, and evening, in a randomized-order repeated-measures design. Sleep characteristics were assessed by actigraphy for 7 days prior to testing. Correlations (Spearman) were computed between all sleep and pain measures. Sleep measures that significantly correlated with pain were entered as covariates in repeated-measures (RM) ANOVA. Longer sleep duration and later sleep timing were associated with increased sensitivity to evoked cold-pain tests at different times of the day (p < 0.05). After controlling for age, BMI, and weekday–weekend differences in sleep duration and bedtime, longer sleep duration, and later wake time were associated with lower pain threshold, and later bed- and wake times were associated with lower pain tolerance (p < 0.05). Sleep quality was not associated with any pain measures. Objectively measured habitual sleep duration and timing are associated with cold-pain perception in healthy young men. Further investigation is needed to elucidate the mechanism underlying the detrimental effects of long sleep duration and late sleep timing on pain perception.

Temporal daily associations among sleep and pain in treatment-seeking youth with acute musculoskeletal pain.

Sleep is an important health risk factor. In the context of pediatric chronic pain, sleep is often impaired and temporal daily associations link sleep deficiency to subsequent increased pain. It is unknown whether similar temporal relationships exist for youth with acute pain. Thus, we characterized sleep in youth with acute musculoskeletal (MSK) pain to examine daily sleep-pain associations. Participants were 67 youth (10-17years) with acute MSK pain (<1month duration). Youth underwent eight nights of actigraphic sleep monitoring and completed twice daily pain diaries. Generalized linear models tested nighttime sleep as a predictor of morning pain, and evening pain as a predictor of nighttime sleep. Shorter sleep duration and poorer sleep quality predicted higher morning pain intensity. However, evening pain did not predict nighttime sleep, suggesting the strongest temporal association is in the direction of sleep deficiency impacting next-day pain, as has been found in prior research in youth with chronic pain.

Changes in coping, pain, and activity after cognitive-behavioral training: a randomized clinical trial for pediatric sickle cell disease using smartphones.

We examined the outcomes of a cognitive-behavioral therapy (CBT) intervention for pain in pediatric sickle cell disease (SCD) using smartphones as a novel delivery method. Forty-six children with SCD received CBT coping skills training using a randomized, waitlist control design. The intervention involved a single session of CBT training and home-based practice using smartphones for 8 weeks. Pre-post questionnaires between the randomized groups were used to evaluate changes in active psychological coping and negative thinking using the Coping Strategies Questionnaire. Daily diaries completed by the full sample during the treatment period were used to assess whether CBT skill use was related to reductions in next-day pain intensity and increases in same-day functional activity. The pre-post group comparison suggested that the youth increased active psychological coping attempts with the intervention. Daily diary data indicated that when children used CBT skills on days with higher pain, there were reductions in next-day pain intensity. There was no such association between skill use and functional activity. CBT coping skills training supported using smartphones can increase coping and reduce pain intensity for children with SCD; however, additions to the study protocols are recommended in future studies. Advantages and caveats of using smartphones are also discussed.

Randomized clinical trial of two anesthetic techniques for intravitreal injections: 4% liquid lidocaine on cotton swabs versus 3.5% lidocaine gel

Objective: To compare same-day and next-day pain control and safety of two anesthetic techniques utilizing 4% liquid lidocaine applied with sterile cotton swabs versus 3.5% lidocaine gel for intravitreal injections. Main outcome measures were: discomfort during anesthetic preparation and needle penetration, 1 and 24 h after injection.Methods: Patients were randomized to alternate anesthetic method at two consecutive injections in one eye or in different eyes on the same day if requiring bilateral injections. Overall satisfaction, corneal staining, and subconjunctival hemorrhage (SCH) were compared.Results: Fifty patients were enrolled. Both methods resulted in similar mild discomfort during anesthetic preparation, 1 and 24 h later. The gel resulted in slightly higher discomfort during needle penetration (p = 0.026). Patients were satisfied with both techniques (p = 0.91), however, 52% patients preferred gel, 33% were indifferent, and 15% preferred cotton swabs (p = 0.002). There were significantly less corneal staining (p = 0.001) and SCH (p = 0.004) after the gel.Conclusion: Both techniques are equally effective and yield mild discomfort scores during the procedure and the next day. The gel method results in significantly less ocular surface irritation.

Daily sleep quality and mood as predictors of pain in children with juvenile polyarticular arthritis.

Children with arthritis experience frequent pain, but the predictors of daily pain variations are largely unidentified. The goal of this study was to examine sleep quality as a predictor of pain in children with arthritis and to determine whether mood moderates this relationship. In this prospective, longitudinal study children with polyarticular arthritis (n = 51, ages 8-16 years) tracked daily symptoms, including sleep quality over 2 months. Self-reported daily pain intensity, as indicated on a visual analog scale, was used as the primary outcome measure in multilevel models. Poorer sleep quality was associated with higher next-day pain ratings (p < .01). Mood moderated this relationship such that as positive mood increased, the relationship between poor sleep quality and high pain weakened (p < .01). Daily pain did not predict nightly sleep quality (p > .05). Sleep quality is an important predictor of pain in children with arthritis. These findings add to the growing body of literature on the use of daily diaries for analyzing patterns of pain, sleep, and mood in children with chronic painful conditions.

Predictors of Pain During and the Day After Corticosteroid Injection for Idiopathic Trigger Finger

Some patients report a transient increase in pain the day after a corticosteroid injection. We investigated factors associated with greater pain during and the day after a corticosteroid injection for idiopathic trigger finger. A total of 100 patients with trigger finger completed questionnaires measuring heightened illness concern, catastrophic thinking, depression, perceived health, expected pain, pain with injection, and pain the day after injection. We performed bivariate analysis to determine variables associated with pain with injection, next-day pain, and next-day pain greater than 4 points on an 11-point ordinal scale. We entered variables with a significant correlation into multivariable linear regression models. The average pain with injection and the day after injection were 4.3 (SD 2.8) and 1.8 (SD 2.0), respectively. Expected pain, heightened illness concern, catastrophic thinking, depression, physician, and gender correlated with pain with injection. A multivariable regression model conducted in backward stepwise fashion demonstrated that physician, depression, expected pain, and female gender explained 28% of the variance in pain with injection. Pain with injection was the only significant predictor of next-day pain and pain greater than 4 points the day after injection. Our data suggest that psychosocial factors are the strongest correlates of pain with corticosteroid injection, but a large portion of the variability remains unexplained. Future research will investigate cognitive/behavioral methods for decreasing pain with injection. Prognostic I.

Daily sleep quality and mood as predictors of pain in children with juvenile polyarticular arthritis

Daily sleep quality and mood as predictors of pain in children with juvenile polyarticular arthritis