Koffel Erin, Kroenke Kurt, Bair Matthew J, Leverty David, Polusny Melissa A, Krebs Erin E
Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System.
VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center.
Health Psychol. 2016 Jan;35(1):41-9. doi: 10.1037/hea0000245. Epub 2015 Jun 15.
The goal of this study was to examine the bidirectional relationship of sleep and pain to determine whether changes in sleep complaints over the course of a chronic pain treatment trial predict pain outcomes and vice versa, controlling for changes in depression and anxiety.
Data were analyzed from a 12-month randomized, controlled trial that tested the effectiveness of a collaborative care intervention for veterans with chronic musculoskeletal pain. Participants were 250 veterans from 5 primary care clinics in a Veteran Affairs (VA) medical center. Measures of pain, sleep, and depression/anxiety symptoms were collected at baseline, 3 months, and 12 months. Factor analysis was used to clarify the boundaries of these domains, and structural equation modeling was used to examine whether changes in sleep complaints and depression/anxiety during the trial predicted pain at the end of the trial, controlling for covariates. An alternative model was also tested in which changes in pain predicted sleep complaints.
Changes in sleep complaints at 3 months significantly predicted changes in pain at 12 months (standardized path coefficient = .29, p < .001). To a lesser extent, changes in pain predicted changes in sleep (standardized path coefficient = .15, p < .05). Changes in depression/anxiety did not significantly predict changes in pain or sleep. There was also evidence of differential relations of specific sleep complaints with pain.
This work helps to further disentangle the complex relationship between pain and sleep. This bidirectional relationship may need to be considered to improve pain outcomes.
本研究的目的是检验睡眠与疼痛之间的双向关系，以确定在慢性疼痛治疗试验过程中睡眠主诉的变化是否能预测疼痛结果，反之亦然，同时控制抑郁和焦虑的变化。
对一项为期12个月的随机对照试验的数据进行分析，该试验测试了一种协作护理干预对患有慢性肌肉骨骼疼痛的退伍军人的有效性。参与者是来自退伍军人事务（VA）医疗中心5个初级保健诊所的250名退伍军人。在基线、3个月和12个月时收集疼痛、睡眠和抑郁/焦虑症状的测量数据。使用因子分析来明确这些领域的界限，并使用结构方程模型来检验试验期间睡眠主诉和抑郁/焦虑的变化是否能预测试验结束时的疼痛，并控制协变量。还测试了一个替代模型，其中疼痛变化预测睡眠主诉。
3个月时睡眠主诉的变化显著预测了12个月时疼痛的变化（标准化路径系数 = 0.29，p < 0.001）。在较小程度上，疼痛变化预测了睡眠变化（标准化路径系数 = 0.15，p < 0.05）。抑郁/焦虑的变化并未显著预测疼痛或睡眠的变化。也有证据表明特定睡眠主诉与疼痛之间存在差异关系。
这项工作有助于进一步理清疼痛与睡眠之间的复杂关系。可能需要考虑这种双向关系以改善疼痛结果。
