Concurrent and longitudinal associations among insomnia symptoms, internalizing problems, and chronic pain in youth.

OBJECTIVE: Although insomnia symptoms and chronic pain are associated, less is known about the temporal nature of the associations between these variables or the impact of internalizing symptoms on the associations. Concurrent and longitudinal associations were examined among insomnia symptoms, internalizing symptoms, and pain in youth with chronic pain in this retrospective analysis of clinical records. We hypothesized the following: (a) pain, insomnia symptoms, and internalizing symptoms would be significantly interrelated at all waves, (b) insomnia symptoms would more strongly predict future pain than the reverse, and (c) internalizing symptoms would mediate the longitudinal association between insomnia symptoms and pain. METHOD: Youth (N = 132; age M = 15.34 years, SD = 1.86 years) were assessed at their initial and two subsequent appointments (time between appointments M = 6.48 months, SD = 4.43 months). At each appointment, youth reported their pain severity, insomnia symptoms, and internalizing symptoms. Confirmatory factor analyses (CFAs) and cross-lagged panel models using structural equation modeling were conducted. CFAs and the cross-lagged panel model with pain and insomnia symptoms as latent constructs converged. RESULTS: Pain and insomnia symptoms were positively correlated within each wave. We found bidirectional longitudinal associations between insomnia symptoms and pain. CONCLUSIONS: Overall, these data demonstrate a bidirectional relationship between insomnia symptoms and pain, as well as weak support for internalizing symptoms mediating the association between pain and insomnia symptoms. Treatment of youth with chronic pain should prioritize concurrent or early treatment of comorbid insomnia symptoms to maximize response to pain treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cross-Sectional Associations among Components of Injustice Appraisals and Functioning in Adolescents With Chronic Pain.

OBJECTIVE: Pain-related appraisals, including pain-related injustice, impact the development and maintenance of chronic pain. This cross-sectional study aimed to examine the relationship between the cognitive-emotional components of pain-related injustice-blame/unfairness and severity/irreparability of loss-and functioning in a mixed sample of adolescents with chronic pain. METHODS: Pediatric patients age 11-18 years (N = 408) completed forms assessing pain-related injustice, pain intensity, and physical and psychosocial functioning as part of their routine assessment in a pediatric chronic pain clinic between January 2014 and January 2019. A series of hierarchical regressions were used to evaluate the relationships among the separate components of pain-related injustice appraisals and functioning. RESULTS: Pain intensity and blame/unfairness appraisals were significantly associated with emotional functioning with blame/unfairness being the stronger association (ß = -.27). Blame/unfairness appraisals, severity/irreparability appraisals, and pain intensity were significantly associated with physical functioning with pain intensity being the strongest association (ß = .36). Pain intensity, blame/unfairness appraisals, and severity/irreparability appraisals were significantly associated with social functioning with blame/unfairness being the strongest association (ß = -.34). Pain intensity and severity/irreparability appraisals were significantly associated with school functioning with severity/irreparability being the stronger association (ß = -.19). CONCLUSIONS: These results lend further support to incorporating pain-related injustice appraisals in standard clinical pain assessments. Treatment practices should target the specific injustice appraisals and domains of functioning impacted for each pediatric patient with chronic pain.

Demographics, Diagnoses, Drugs, and Adjuvants in Patients on Chronic Opioid Therapy vs. Intermittent Use in a Tertiary Pediatric Chronic Pain Clinic.

Anywhere from 11.6% to 20% of pediatric and adolescent patients treated for chronic pain are prescribed opioids, but little is known about these patients. The purpose of this study was to determine the characteristics of patients on chronic opioid therapy (COT) and what therapies had been utilized prior to or in conjunction with COT. The study was a retrospective chart review of all chronic pain patients seen during 2020 with those patients on COT separated for analysis. A total of 346 unique patients were seen of which 257 were female (74.3%). The average age was 15.5 years. A total of 48 patients (13.9%) were identified as being on COT with an average age of 18.1 years. Of these, 23 (47.9%) were male which was significantly more than expected. The most common reason for patients to be receiving COT was palliative (13/48), and the second most common was sickle cell anemia (10/48). Patients on COT were significantly more likely to be male, be older, and to be concurrently prescribed benzodiazepines. Concurrent opioid and benzodiazepine therapy is a risk factor for respiratory depression and overdose. Further investigation into the increased proportion of males and benzodiazepine usage in patients on COT is warranted.