Presented at the 2013 AAPM Annual Meeting « Back

Pain and Sleep: Findings from Patients Participating in a Chronic Pain Rehabilitation Program

Sara A. Davin, PsyD MPH, davins@ccf.org¹, Josh Wilt, MS², Judith Scheman, PhD², Edward C. Covington, MD⁴, (1) Cleveland Clinic Neurological Center for Pain, Cleveland, Ohio, (2) Cleveland Clinic, Cleveland, Ohio, (3) Cleveland Clinic Foundation, Shaker Heights, Ohio

Sleep difficulties are common among patients with chronic pain. It is unclear whether treating pain is sufficient for reducing sleep disturbance or whether treating sleep problems ameliorates pain. This study explored the pain-sleep connection, within the context of a ~3 week comprehensive chronic pain rehabilitation program (CPRP). Fifty patients completed daily measures of pain, sleep, depression, and anxiety, which were examined by the use of multilevel models (MLMs). Patients who reported a greater number of hours of sleep reported less pain and scored lower on scales measuring depression and anxiety. The association remained when controlling for day in treatment, anxiety, and depression. Associations between sleep, depression and anxiety were not upheld when controlling for day in treatment and pain. Further correlational analyses (b coefficients and multiple regression) did not reach statistical significance, indicating that people who get remission from pain do not necessarily get remission from sleep difficulties, and vice versa. This finding remained robust when controlling for average duration of sleep and for sleep on day 1 of treatment. That is, regardless of how well individuals slept over the course of treatment and how they were sleeping when they came in for treatment, sleep difficulty remission did not associate with pain remission. These results provide preliminary evidence that pain and sleep difficulties decrease over the course of treatment in a CPRP. However, findings do not confirm that the treatment of pain produces improvements in sleep or that improved sleep results in less pain.

Funding: None