Sleep disturbance, psychosocial distress important targets for long-term chronic pain management

Reductions in pain intensity may not be the earliest signs of improvement chronic pain patients show in response to effective pain management, a recent study has shown.

“This study demonstrates that pain intensity scores are not robust predictors of psychosocial outcomes longitudinally. Instead, other factors such as sleep initiation, psychological distress, and disability appear to be important targets for intervention that may promote effective pain reduction,” the researchers said.

Using retrospectively collected data from 666 treatment-seeking patients (mean age 49.6 years, 67.9 percent women) with chronic pain, cross-lagged models were constructed to evaluate the relationship between average pain intensity and disability, sleep initiation and maintenance, and psychological distress. The analysis was conducted over a 1-year time span.

The models showed that greater pain-related interference with sleep maintenance, but not sleep initiation, was significantly predictive of higher pain intensity at the following time point (p=0.039).

In addition, more severe baseline symptoms of depression (p=0.011), as well as anxiety (p=0.025) and disability (p<0.001) significantly correlated with worse pain intensity at the next time point.

In contrast, pain intensity had no such lagged effect on depression, anxiety, or disability.

The findings point to a complex temporal relationship among pain intensity and other clinical indicators of chronic pain. In particular, while pain intensity showed an initial lagged effect on sleep at a follow-up time point, the lack of a similar effect on other pertinent variables suggests that intensity need not be the central measure of improvement following treatment.

“Our results highlight the need for multifactorial assessment and treatment of individuals with chronic pain and, further, suggest that it may not be necessary to reduce pain intensity before improvements in sleep, mood, and function can occur,” the researchers said.