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A longitudinal study of bidirectional associations between frequent pain and insomnia symptoms in adolescents

      Abstract

      Background

      Chronic pain and insomnia symptoms are prevalent in adolescents. This study examined the prospective associations between pain and insomnia symptoms in a large sample of adolescents.

      Methods

      A total of 7072 adolescents (mean age = 14.6 years) participated in a longitudinal study of behavior and health in Shandong, China. A baseline survey was conducted in November-December of 2015, and a follow-up survey was conducted one year later. A self-administered questionnaire was used to assess headache, stomachache, other nonspecific pain, depression, substance use, and family environment. The Youth Self-Rating Insomnia Scale was used to measure insomnia symptoms.

      Results

      At baseline and 1-year follow-up, frequent pain was reported by 8.4% and 7.8% of the sample, respectively; moderate to severe insomnia symptoms were reported by 15.2% and 14.8%, respectively. Logistic regression analyses showed that frequent pain at baseline was significantly associated with increased odds of incident insomnia symptoms at 1-year follow-up (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.23-2.34) while adjusting for adolescent and family covariates. On the other hand, insomnia symptoms at baseline were significantly associated with increased odds of incident frequent pain at 1-year follow-up (OR = 2.00, 95% CI = 1.50-2.68). The 3 types of pain (ie, headache, stomachache, and other nonspecific pain) had similar associations with insomnia symptoms.

      Conclusions

      The findings suggest that the associations between frequent pain and insomnia are bidirectional, independent of multiple adolescent and family covariates. These findings stress the importance of assessment and management of both pain and insomnia symptoms in adolescents in routine clinical practice and school-based intervention programs.

      Keywords

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      References

        • Owens J.
        Insufficient sleep in adolescents and young adults: an update on causes and consequences.
        Pediatrics. 2014; 134: e921-e932
        • Liu X
        • Zhou H.
        Sleep duration, insomnia and behavioral problems among Chinese adolescents.
        Psychiatry Res. 2002; 111: 75-85
        • Dahl RE
        • Lewin DS.
        Pathways to adolescent health sleep regulation and behavior.
        J Adolesc Health. 2002; 31: 175-184
        • Liu X
        • Liu ZZ
        • Wang ZY
        • Yang Y
        • Liu BP
        • Jia CX.
        Daytime sleepiness predicts future suicidal behavior: a longitudinal study of adolescents.
        Sleep. 2019; 42https://doi.org/10.1093/sleep/zsy225
        • Allen JM
        • Graef DM
        • Ehrentraut JH
        • Tynes BL
        • Crabtree VM.
        Sleep and pain in pediatric illness: a conceptual review.
        CNS Neurosci Ther. 2016; 22: 880-893
        • Badawy SM
        • Law EF
        • Palermo TM.
        The interrelationship between sleep and chronic pain in adolescents.
        Curr Opin Physiol. 2019; 11: 25-28
        • Valrie CR
        • Bromberg MH
        • Palermo T
        • Schanberg LE.
        A systematic review of sleep in pediatric pain populations.
        J Dev Behav Pediatr. 2013; 34: 120-128
        • Raja SN
        • Carr DB
        • Cohen M
        • et al.
        The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises.
        Pain. 2020; 161: 1976-1982
        • King S
        • Chambers CT
        • Huguet A
        • et al.
        The epidemiology of chronic pain in children and adolescents revisited: a systematic review.
        Pain. 2011; 152: 2729-2738
        • Forgeron PA
        • King S
        • Stinson JN
        • McGrath PJ
        • MacDonald AJ
        • Chambers CT.
        Social functioning and peer relationships in children and adolescents with chronic pain: a systematic review.
        Pain Res Manag. 2010; 15: 27-41
        • Palermo TM
        • Toliver-Sokol M
        • Fonareva I
        • Koh JL.
        Objective and subjective assessment of sleep in adolescents with chronic pain compared to healthy adolescents.
        Clin J Pain. 2007; 23: 812-820
        • Palermo TM
        • Law E
        • Churchill SS
        • Walker A.
        Longitudinal course and impact of insomnia symptoms in adolescents with and without chronic pain.
        J Pain. 2012; 13: 1099-1106
        • Carskadon MA.
        Sleep in adolescents: the perfect storm.
        Pediatr Clin North Am. 2011; 58: 637-647
        • de Zambotti M
        • Goldstone A
        • Colrain IM
        • Baker FC.
        Insomnia disorder in adolescence: diagnosis, impact, and treatment.
        Sleep Med Rev. 2018; 39: 12-24
        • Yuksel D
        • Prouty D
        • Bei B
        • Baker FC
        • de Zambotti M.
        Re-thinking insomnia disorder in adolescents: the importance of an accurate diagnosis.
        Sleep. 2021; 44https://doi.org/10.1093/sleep/zsab221
        • Angold A
        • Costello EJ
        • Worthman CM.
        Puberty and depression: the roles of age, pubertal status and pubertal timing.
        Psychol Med. 1998; 28: 51-61
        • Jansson-Frojmark M
        • Boersma K.
        Bidirectionality between pain and insomnia symptoms: a prospective study.
        Br J Health Psychol. 2012; 17: 420-431
        • Alvaro PK
        • Roberts RM
        • Harris JK.
        A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression.
        Sleep. 2013; 36: 1059-1068
        • Long AC
        • Krishnamurthy V
        • Palermo TM.
        Sleep disturbances in school-age children with chronic pain.
        J Pediatr Psychol. 2008; 33: 258-268
        • Finan PH
        • Goodin BR
        • Smith MT.
        The association of sleep and pain: an update and a path forward.
        J Pain. 2013; 14: 1539-1552
        • Liu XC
        • Chen H
        • Liu ZZ
        • Wang JY
        • Jia CX.
        Prevalence of suicidal behaviour and associated factors in a large sample of Chinese adolescents.
        Epidemiol Psychiatr Sci. 2019; 28: 280-289
        • Liu X
        • Chen H
        • Liu ZZ
        • Jia CX.
        Insomnia and psychopathological features associated with restless legs syndrome in Chinese adolescents.
        J Clin Psychiatry. 2018; 79https://doi.org/10.4088/JCP.16m11358
        • Liu XC
        • Yang YY
        • Liu ZZ
        • Luo YC
        • Fan F
        • Jia CX.
        Psychometric properties of Youth Self-Rating Insomnia Scale (YSIS) in Chinese adolescents.
        Sleep Biol Rhythms. 2019; 17: 339-348
        • Achenbach TM.
        Manual for the Youth Self-Report and 1991 Profile.
        Department of Psychiatry, University of Vermont, Burlington, VT1991
        • Liu X
        • Guo CQ
        • Liu LQ
        • Sun LM.
        Reliability and validity of the Youth Self-Report (YSR) of Achenbach's Child Behavior Checklist (CBCL) [in Chinese].
        Chin Ment Health J. 1997; 11: 200-203
        • Liu X
        • Liu ZZ
        • Yang Y
        • Jia CX.
        Prospective associations of frequent pain symptoms with suicidal behavior in adolescents.
        J Pain. 2021; 22: 852-863
        • Koenig J
        • Oelkers-Ax R
        • Parzer P
        • et al.
        The association of self-injurious behaviour and suicide attempts with recurrent idiopathic pain in adolescents: evidence from a population-based study.
        Child Adolesc Psychiatry Ment Health. 2015; 9: 32
        • Hu L
        • Liu ZZ
        • Wang Z
        • Jia CX
        • Liu X.
        Associations between pain and depressive symptoms: a longitudinal study of Chinese adolescents.
        J Affect Disord. 2022; 299: 675-681
        • Radloff LS.
        The CES-D scale: a self-report depression scale for research in the general population.
        Appl Psychol Meas. 1977; 1: 385-401
        • Hysing M
        • Pallesen S
        • Stormark KM
        • Lundervold AJ
        • Sivertsen B.
        Sleep patterns and insomnia among adolescents: a population-based study.
        J Sleep Res. 2013; 22: 549-556
        • Liu X
        • Uchiyama M
        • Okawa M
        • Kurita H.
        Prevalence and correlates of self-reported sleep problems among Chinese adolescents.
        Sleep. 2000; 23: 27-34
        • Liu X
        • Zhao Z
        • Jia C
        • Buysse DJ.
        Sleep patterns and problems among Chinese adolescents.
        Pediatrics. 2008; 121: 1165-1173
        • Chen H
        • Bo QG
        • Jia CX
        • Liu X.
        Sleep problems in relation to smoking and alcohol use in Chinese adolescents.
        J Nerv Ment Dis. 2017; 205: 353-360
        • Zhang J
        • Chan NY
        • Lam SP
        • et al.
        Emergence of sex differences in insomnia symptoms in adolescents: a large-scale school-based study.
        Sleep. 2016; 39: 1563-1570
        • Afolalu EF
        • Ramlee F
        • Tang NKY.
        Effects of sleep changes on pain-related health outcomes in the general population: a systematic review of longitudinal studies with exploratory meta-analysis.
        Sleep Med Rev. 2018; 39: 82-97
        • Besedovsky L
        • Lange T
        • Haack M.
        The sleep-immune crosstalk in health and disease.
        Physiol Rev. 2019; 99: 1325-1380
        • Karshikoff B
        • Tadros MA
        • Mackey S
        • Zouikr I.
        Neuroimmune modulation of pain across the developmental spectrum.
        Curr Opin Behav Sci. 2019; 28: 85-92
        • Finan PH
        • Smith MT.
        The comorbidity of insomnia, chronic pain, and depression: dopamine as a putative mechanism.
        Sleep Med Rev. 2013; 17: 173-183
        • Yang J
        • Lo WLA
        • Zheng F
        • Cheng X
        • Yu Q
        • Wang C.
        Evaluation of cognitive behavioral therapy on improving pain, fear avoidance, and self-efficacy in patients with chronic low back pain: a systematic review and meta-analysis.
        Pain Res Manag. 2022; 20224276175
        • Selvanathan J
        • Pham C
        • Nagappa M
        • et al.
        Cognitive behavioral therapy for insomnia in patients with chronic pain—a systematic review and meta-analysis of randomized controlled trials.
        Sleep Med Rev. 2021; 60101460