Center for Innovation in Sleep Self-Management

PI: Tonya Palermo; Co-Investigator: Teresa M. Ward

NINR/NIH R21 NR017312

Five to 8% of youth report severe chronic pain and disability. Sleep deficiency, including reduced quantity and quality of sleep, is common and highly comorbid in an estimated 50% of youth with chronic pain. Sleep deficiency contributes to greater disability, poorer quality of life, and increased health care use. History of childhood chronic pain places youth at risk for a lifelong pattern of pain and disability and high health care costs in adulthood. Thus, finding effective methods that support youth in the self-management of pain is a priority. Although progress has been made in establishing pain self-management interventions for youth, treatments produce small to moderate effect sizes, gains may not persist, and many patients derive little or no benefit. Our preliminary data suggest that youth with greater sleep deficiency find pain self-management intervention less acceptable and make fewer gains in pain-related outcomes, indicating that sleep may represent an overlooked health factor influencing youth’s self-management skills. Sleep and pain share a bidirectional relationship, and data indicate that sleep deficiency increases pain sensitivity in adults and children. In addition to the direct effect of sleep on pain, sleep deficiency is associated with a number of areas that may influence self-management skills including deficits in complex cognitive functions and reduced self- regulatory skills. However, to date, studies have not determined the impact of sleep deficiency on self- management of pediatric chronic pain. Therefore, the objective of this application is to characterize how sleep deficiency influences youth’s ability to engage with, implement, and benefit from a pain self-management intervention. We will study a cohort of 80 youth, ages 12 to 17 years, with chronic musculoskeletal, head, or abdominal pain. Assessments will occur at baseline, immediately after intervention, and repeated at 3 months post-intervention. Mediators will be assessed at an additional mid-treatment (4 weeks) data point. All youth will receive an internet-delivered pain self- management intervention over an 8-week period.