Disrupted sleep has long been associated with physical functioning and disability in chronic pain populations and recent research shows that patterns of sleep and rest can predict physical disability, independent of depression and pain levels in this group. However, it is unknown whether sleep quality may independently predict disability in this way. The aim of the present study was to examine the self-reported relationship between sleep and disability in 155 chronic pain patients attending a pain management service. The sample had an average age of 52.9 years and 69% were female with mean pain duration of 10.5 years. Disrupted sleep and rest patterns and poor sleep quality were positively correlated with depression and pain-related disability. Hierarchical regression analyses showed that sleep quality did not predict pain-related disability when depression and pain severity were taken into consideration. Separate mediation analyses of depression and pain severity revealed that both variables were important partial mediators of the relationship between sleep quality and disability. Depression was found to be a stronger mediator than pain severity. These findings highlight the important role of sleep in chronic pain suffering. However, due to the cross sectional nature of this study, the mediation pathways proposed require testing by further research adopting a prospective design. Ideally, future research should evaluate whether targeted interventions to improve sleep can reduce pain severity, depression and ultimately, pain-related disability.

Eight women with Chronic Pelvic Pain (CPP) were asked, by means of semi-structured interview, what had been helpful and unhelpful in terms of social support from their partners, families, friends, acquaintances, doctors, nurses and other women with CPP. Firstly, thematic analysis employing a pre-defined social support category system revealed that particular forms of tangible support were preferred from specific support providers but emotional and informational support was appreciated from the whole support network. Secondly, interpretative phenomenological analysis revealed three major additional themes: 'Pain and Suffering' described the trauma suffered by these patients and the anger and anxiety surrounding their experience; 'Ideal Social Support' revealed a picture of desired support consisting of enduring emotional and practical support which did not undermine individual autonomy; 'Shortfalls in Social Support' had subsidiary themes entitled 'Lack of empathy' and 'Lack of engagement'. These themes were described and discussed in relation to each other, extant research and their clinical implications.

There has been considerable interest in the application of the Stages of Change model developed by Prochaska and DiClemente. Much ha s b e e n written about the model's implications for lifestyle change interventions, and national training programmes are underway to train health care staff to provide brief stage-specific interventions. However, the r e i s , as yet, relatively little evidence comparing stage-based with non-stage-based interventions. It is argued from this review of the evidence that it is difficult to generalise from existing research t o s u p p o r t b r i e f s t a f f -t r a i n i n g a p p r o a c h e s .

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