The role of sleep quality on the relationship between posttraumatic stress symptoms and pain in women
Pain frequently co-occurs with elevated posttraumatic stress symptoms (PTSS); women are at elevated risk for their co-occurrence. PTSS and pain are associated with poor sleep quality; yet, little research has examined how sleep impacts their co-occurrence. The current study examines the indirect role of sleep on the relationship between PTSS and pain. A community sample of 182 women completed psychometrically-sound questionnaires assessing PTSS, sleep quality, pain characteristics, depression and anxiety symptoms, and anxiety sensitivity. We examined how sleep quality impacted associations among PTSS and pain intensity and pain interference, while controlling for key psychological factors. Greater PTSS was associated with worse pain interference, and poor sleep quality had a significant indirect effect on this relationship. Sleep may represent a modifiable behavioral mechanism that contributes to the mutual maintenance of PTSS and pain in women. Future research is needed to further clarify the role of sleep quality in their co-occurrence.
KeywordsChronic pain Posttraumatic stress disorder Sleep quality
We thank Caitlin Murrary for her assistance in the revision of this manuscript.
Rachel Aaron is supported by T32GM086270 awarded to Tonya Palermo; Tonya Palermo is supported by K24HD060068; Melanie Noel is supported by the Vi Riddell Pain Initiative of the Alberta Children’s Hospital Research Institute. This research was supported by a Hearst Grant awarded to Melanie Noel by the Center for Child Health, Behavior and Development at the Seattle Children’s Hospital Research Institute.
Compliance with ethical standards
Conflict of interest
Rachel Aaron, Melanie Noel, Joanne Dudeney, Anna Wilson, Amy Holley, and Tonya Palermo declare that they have no conflict of interest.
Human and animal rights and Informed consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
- APA. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 ® ). American Psychiatric Pub.Google Scholar
- Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., et al. (2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders—fifth edition (PCL-5) in veterans. Psychological Assessment, 28, 1379.CrossRefGoogle Scholar
- Deimling, G. T., Bowman, K. F., Sterns, S., Wagner, L. J., & Kahana, B. (2006). Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 15, 306–320.CrossRefGoogle Scholar
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245–258.CrossRefGoogle Scholar
- Lillis, T. A., Gerhart, J., Bouchard, L. C., Cvengros, J., O’Mahony, S., Kopkash, K.,… Burns, J. (2017). Sleep disturbance mediates the association of post-traumatic stress disorder symptoms and pain in patients with cancer. American Journal of Hospice and Palliative Medicine ®, 1049909117739299.Google Scholar
- Merskey, H., & Bogduk, N. (1994). Classification of chronic pain (2nd ed.). Seattle: IASP.Google Scholar
- Nelson, S. M., Cunningham, N. R., & Kashikar-Zuck, S. (2017). A conceptual framework for understanding the role of adverse childhood experiences in pediatric chronic pain. The Clinical Journal of Pain, 33, 264–270.Google Scholar
- Pavlova, M., Ference, J., Hancock, M., & Noel, M. (2017). Disentangling the sleep-pain relationship in pediatric chronic pain: The mediating role of internalizing mental health symptoms. Pain research and management, 2017.Google Scholar