RESUMO
Individuals with chronic pain report disproportionally higher rates of trauma, yet it is unclear whether different types of trauma (eg, sexual, accidental trauma) are associated with worse pain outcomes. The present study sought to 1) identify subgroups of people with chronic pain based on trauma type, and 2) determine whether subgroups differ in terms of pain characteristics over a 2-year period. Individuals with chronic pain (N = 1,451) participated in an online study and completed self-report questionnaires at baseline, 3-, 12-, and 24-month follow-up. Trauma was assessed via the Life Events Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Pain intensity and interference were measured via the Brief Pain Inventory, and pain distribution was evaluated using the Widespread Pain Index. Latent class analyses produced a 3-class solution consisting of individuals with high and diverse trauma (16.3%), high sexual trauma (18.4%), and low/accidental trauma (57.1%) with the rest of the sample endorsing no trauma history (8.2%). After controlling for key demographic variables and baseline outcome levels, individuals in the high- and diverse trauma group endorsed higher levels of pain severity and interference at the 3- and 12-month follow-ups compared with the group with no trauma (P < .01). Additionally, relative to the no trauma group, individuals in the high sexual trauma group reported higher levels of pain interference and more widespread pain at the 3-month follow-up (P < .05). The findings underscore the importance of screening for trauma and suggest that the type and variety of trauma experienced may be relevant to pain-related outcomes. PERSPECTIVE: This article highlights how an individual's unique trauma history may be related to their current pain experience. Knowledge of the type and frequency of past trauma may have relevant clinical implications for the treatment of chronic pain.
RESUMO
Studies have identified insomnia as having significant influence on chronic pain. A rising body of research has also underscored the association between eveningness and chronic pain. However, co-assessment of insomnia and eveningness in the context of chronic pain adjustment has been limited. The present study sought to investigate the effects of insomnia and eveningness on pain severity, pain interference, and emotional distress (ie, depressive and anxiety symptoms) over nearly 2 years among adults with chronic pain in the U.S. Adults with chronic pain (N = 884) were surveyed 3 times via Amazon's MTurk online crowdsourcing platform: baseline, 9-month follow-up, and 21-month follow-up. Path analysis was conducted to examine the effects of baseline insomnia severity (Insomnia Severity Index) and eveningness (Morningness and Eveningness Questionnaire), as well as their moderating effects on outcomes. Controlling for select sociodemographic variables and baseline outcome levels, greater insomnia severity at baseline was associated with worsening of all of the pain-related outcomes at 9-month follow-up, and pain interreference and emotional distress at 21-month follow-up. We did not find evidence that evening types are at a higher risk of experiencing worsening pain-related outcomes over time compared to morning and intermediate types. There were also no significant insomnia severity and eveningness moderation effects on any outcome. Our findings suggest that insomnia is a more robust predictor of changes in pain-related outcomes as compared to eveningness. Treatment of insomnia can be important in chronic pain management. Future studies should evaluate the role of circadian misalignment on pain using more accurate biobehavioral makers. PERSPECTIVE: This study examined the effects of insomnia and eveningness on pain and emotional distress in a large sample of individuals with chronic pain. Insomnia severity is a stronger predictor of changes in pain and emotional distress than eveningness, highlighting insomnia as an important clinical target for chronic pain management.