Sleep among Youth with Severely Disabling Chronic Pain: Before, during, and after Inpatient Intensive Interdisciplinary Pain Treatment

Abstract

Poor sleep is commonly reported in pediatric chronic pain. There are signals that intensive interdisciplinary pain treatments (IIPT) may inadvertently improve objective sleep, but this claim cannot be substantiated without baseline sleep data prior to IIPT. This study followed the objective sleep/wake patterns (e.g., duration, quality, timing, consistency) of pediatric patients with severely functionally disabling chronic pain before, during, and after inpatient IIPT (the Functional Independence Restoration Program—“FIRST Program”), alongside a similarly-disabled chronic pain Comparison Group. The final sample included N = 10 FIRST Patients and N = 9 Comparison Group patients. At baseline, the whole sample showed healthy sleep duration (~9 h), average sleep efficiency <90%, late sleep onset and offset (mean = 11:56 p.m.–8:50 a.m.), and highly inconsistent sleep schedules night to night. During IIPT, FIRST Patients maintained healthy sleep durations, moved sleep schedules 2 h earlier, and decreased timing and duration variability by >60 min while the Comparison Group maintained similar sleep to baseline. At follow up (1–2 months later), FIRST Patients’ sleep schedules shifted later but were still less variable than at baseline. Results point to the malleability of sleep/wake patterns within treatment contexts with strict environmental control but suggest that these gains may be difficult for youth with chronic pain to maintain in the home environment.

Effect of percutaneous electrical nerve field stimulation on mechanosensitivity, sleep, and psychological comorbidities in adolescents with functional abdominal pain disorders

“…Baseline actigraphy data prior to PENFS were not obtained due to the nature of the study. The measures generated included time in bed, total sleep time, sleep efficiency (percentage of the estimated total sleep time and time spent in bed), sleep latency (duration in minutes to fall sleep), wake after sleep onset (WASO—time spent awake after going to sleep), and sleep onset variability (each patient's personal standard deviation in sleep onset) 22‐24 …”

“…[15][16][17][18] Sleep disturbances may be a result of pain, but have also been suggested to worsen pain in children with chronic pain conditions. [19][20][21][22][23][24] Preclinical and clinical data have shown increased pain sensitivity with sleep deprivation, and there is some suggestion that interventions directed toward sleep improve pain. [25][26][27][28] All of these factors potentially contribute to the severity of symptoms in FAPD.…”

“…Catastrophizing and somatization have shown to result in worse psychosocial and functional outcomes 15‐18 . Sleep disturbances may be a result of pain, but have also been suggested to worsen pain in children with chronic pain conditions 19‐24 . Preclinical and clinical data have shown increased pain sensitivity with sleep deprivation, and there is some suggestion that interventions directed toward sleep improve pain 25‐28 .…”

Intensive interdisciplinary pain treatment for children and adolescents with chronic noncancer pain: a preregistered systematic review and individual patient data meta-analysis

“…From September 2020 to September 2021, we obtained data or sufficient summary statistics for 13 studies and included them 6,19,29,43,73,80,92,99,101,119,120,141,144 in the quantitative analysis, comprising 50% of all relevant studies. Quantitative metaanalyses (including study characteristics) were presented for only those 13 studies.…”

“…43 All others were nonrandomized, uncontrolled longitudinal single-arm studies. The 2 exceptions were the RCT by Flack et al, 29 which was treated in this meta-analysis as a nonrandomized study with 2 sub studies, and the nonrandomized controlled study by Krietsch et al, 73 of which only the IIPT group was considered here.…”