Linking Nonrestorative Sleep and Activity Interference Through Pain Catastrophizing and Pain Severity: An Intraday Process Model Among Individuals With Fibromyalgia

Abstract

Nonrestorative sleep is a key diagnostic feature of the musculoskeletal pain disorder fibromyalgia and is robustly associated with poor physical functioning, including activity interference. However, the mechanisms through which nonrestorative sleep elicits activity interference among individuals with fibromyalgia at the within-person level remain unclear. The present study tested the following 3-path mediation model, using data gathered from a 21-day electronic daily diary in 220 individuals with fibromyalgia: previous night nonrestorative sleep ! morning pain catastrophizing ! afternoon pain severity ! end-of-day activity interference. Results of multilevel structural equation modeling supported the 3-path mediation model. Previous night's nonrestorative sleep and morning pain catastrophizing were also directly related to end-of-day activity interference. Previous night nonrestorative sleep did not significantly predict afternoon pain severity while controlling for the effect of morning pain catastrophizing. Greater nonrestorative sleep during the previous night and a higher level of morning pain catastrophizing appear to serve as risk factors for experiencing greater daily pain and activity interference later in the day. These findings point to the potential utility of targeted interventions that improve both sleep quality and pain catastrophizing to help individuals with chronic pain engage in important daily activities despite experiencing pain. Perspective: This study provides a better understanding of how nonrestorative sleep is associated with daily activity interference among individuals with fibromyalgia. An intervention that targets attenuating nonrestorative sleep and pain catastrophizing may help improve daily physical functioning of this population.

Contextualizing goal preferences in fear-avoidance models. Looking at fatigue as a disabling symptom in fibromyalgia patients

“…A catastrophic misinterpretation of pain leads to an excessive fear of pain/injury which in turn leads to the avoidance of physical activity what contributes to exacerbate pain and disability [ 9 ]. The previous associations find evidence in the fact that pain catastrophizing is one of the most widely investigated and robust psychological predictors of poor outcomes in fibromyalgia, in particular, and chronic pain in general [ 10 , 11 ].…”

Working Memory Performance, Pain and Associated Clinical Variables in Women With Fibromyalgia

“…However, other studies suggest that alterations in cognitive performance may persist even when patients’ sleep problems are controlled for Dick et al (2008) . Although FM patients report a high prevalence of sleep problems ( Anderson et al, 2012 ; Andrade et al, 2020 ; Mun et al, 2020 ; Türkoğlu and Selvi, 2020 ), the neurobiological characteristics underlying these problems and their relationship to nociceptive and cognitive impairment have not yet been fully investigated ( Ceko et al, 2012 ).…”

High-resolution, field approaches for assessing pain: Ecological Momentary Assessment

“…Eleven original articles were found that reported results from 9 different projects (see Supplemental Table 1, available at http://links.lww.com/PAIN/B159 ). 6 , 7 , 9 , 15 , 19 , 28 , 38 , 42 , 49 , 55 All the studies were observational designs and most investigated pain intensity, 9 , 15 , 19 , 28 , 34 , 38 , 42 , 49 , 55 pain interference, 7 , 19 , 27 and pain behavior, 19 or examined relationships between pain and other domains (such as sleep 55 or social support 9 ). One study took a more methodological approach investigating the feasibility of promising statistical models.…”

“…This “within-couples” design allowed the authors to show that increases in pain catastrophizing of patients were positively associated with spouse reports of patient pain behavior in concurrent and lagged analyses. In lagged analyses, Mun 34 used a structural equation modeling framework to investigate whether morning pain catastrophizing and afternoon pain severity sequentially mediated the relationship between previous night nonrestorative sleep and end-of-day activity interference. It should be clear that addressing questions like these would not be possible without repeated, momentary assessment data.…”