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Catastrophizing and acceptance are mediators between insomnia and pain intensity—an SQRP study of more than 6,400 patients with non-malignant chronic pain conditions

Gerdle, Björn ; Dragioti, Elena ; Rivano Fischer, Marcelo LU ; Dong, Huan Ji and Ringqvist, Åsa LU (2023) In Frontiers in Pain Research 4.
Abstract

Background: Sleep problems (insomnia) and chronic pain are associated. Chronic pain and insomnia/insufficient sleep quality share similar symptoms and features. Although they have a bidirectional relationship, more research is needed to understand how they interact via mediators and how moderators influence this relationship. Aims: In this large clinical registry-based cohort study (N = 6,497), we investigate important mediators between insomnia and pain intensity in a cross-sectional sample of chronic pain patients using advanced path analysis. In addition, we investigate whether some background variables were moderators of the identified important paths or not and the correlation patterns between insomnia and pain intensity in... (More)

Background: Sleep problems (insomnia) and chronic pain are associated. Chronic pain and insomnia/insufficient sleep quality share similar symptoms and features. Although they have a bidirectional relationship, more research is needed to understand how they interact via mediators and how moderators influence this relationship. Aims: In this large clinical registry-based cohort study (N = 6,497), we investigate important mediators between insomnia and pain intensity in a cross-sectional sample of chronic pain patients using advanced path analysis. In addition, we investigate whether some background variables were moderators of the identified important paths or not and the correlation patterns between insomnia and pain intensity in relation to the mediators. Methods: This study includes a cohort of adult patients with chronic non-cancer pain from the Swedish Quality Registry for Pain Rehabilitation (SQRP) with data on patient-reported outcome measures (PROMs) (2008–2016). The PROMs cover the background, pain aspects, psychological distress, pain-related cognitions, activity/participation, and health-related quality of life variables of the patients. Partial least squares structural equation modeling was used to explore the direct and indirect (via mediators) relationships between insomnia and pain intensity at baseline. Results: In this cohort study, insomnia was prevalent at 62.3%, and both direct and indirect mediating paths were present for the insomnia–pain intensity relationship. All of the mediating effects combined were weaker than the direct effect between insomnia and pain intensity. The mediating effects via catastrophizing and acceptance showed the strongest and equal mediating paths, and mediating effects via fear avoidance were the second strongest. Insomnia showed stronger direct significant correlations with psychological distress, catastrophizing, and acceptance compared with those of pain intensity. Sex, age, education level, spatial extent of pain, or body mass index did not moderate the mediating paths. Discussion and conclusion: This study confirms the existence of significant direct and mediating paths between reported insomnia and pain intensity. Future studies should focus on illuminating how sleep interventions influence pain intensity and other important key factors that contribute to the distress of chronic pain patients.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acceptance, anxiety, catastrophizing, depression, fear avoidance, insomnia, pain, physical activity
in
Frontiers in Pain Research
volume
4
article number
1244606
publisher
Frontiers Media S. A.
external identifiers
  • scopus:85173697438
  • pmid:37828972
ISSN
2673-561X
DOI
10.3389/fpain.2023.1244606
language
English
LU publication?
yes
id
3f55002e-bdd1-4bce-a797-7944d315b6c0
date added to LUP
2023-12-20 10:49:56
date last changed
2024-07-12 04:06:48
@article{3f55002e-bdd1-4bce-a797-7944d315b6c0,
  abstract     = {{<p>Background: Sleep problems (insomnia) and chronic pain are associated. Chronic pain and insomnia/insufficient sleep quality share similar symptoms and features. Although they have a bidirectional relationship, more research is needed to understand how they interact via mediators and how moderators influence this relationship. Aims: In this large clinical registry-based cohort study (N = 6,497), we investigate important mediators between insomnia and pain intensity in a cross-sectional sample of chronic pain patients using advanced path analysis. In addition, we investigate whether some background variables were moderators of the identified important paths or not and the correlation patterns between insomnia and pain intensity in relation to the mediators. Methods: This study includes a cohort of adult patients with chronic non-cancer pain from the Swedish Quality Registry for Pain Rehabilitation (SQRP) with data on patient-reported outcome measures (PROMs) (2008–2016). The PROMs cover the background, pain aspects, psychological distress, pain-related cognitions, activity/participation, and health-related quality of life variables of the patients. Partial least squares structural equation modeling was used to explore the direct and indirect (via mediators) relationships between insomnia and pain intensity at baseline. Results: In this cohort study, insomnia was prevalent at 62.3%, and both direct and indirect mediating paths were present for the insomnia–pain intensity relationship. All of the mediating effects combined were weaker than the direct effect between insomnia and pain intensity. The mediating effects via catastrophizing and acceptance showed the strongest and equal mediating paths, and mediating effects via fear avoidance were the second strongest. Insomnia showed stronger direct significant correlations with psychological distress, catastrophizing, and acceptance compared with those of pain intensity. Sex, age, education level, spatial extent of pain, or body mass index did not moderate the mediating paths. Discussion and conclusion: This study confirms the existence of significant direct and mediating paths between reported insomnia and pain intensity. Future studies should focus on illuminating how sleep interventions influence pain intensity and other important key factors that contribute to the distress of chronic pain patients.</p>}},
  author       = {{Gerdle, Björn and Dragioti, Elena and Rivano Fischer, Marcelo and Dong, Huan Ji and Ringqvist, Åsa}},
  issn         = {{2673-561X}},
  keywords     = {{acceptance; anxiety; catastrophizing; depression; fear avoidance; insomnia; pain; physical activity}},
  language     = {{eng}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Pain Research}},
  title        = {{Catastrophizing and acceptance are mediators between insomnia and pain intensity—an SQRP study of more than 6,400 patients with non-malignant chronic pain conditions}},
  url          = {{http://dx.doi.org/10.3389/fpain.2023.1244606}},
  doi          = {{10.3389/fpain.2023.1244606}},
  volume       = {{4}},
  year         = {{2023}},
}