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Pain, depression, and sleep difficulties in adolescents
Abstracts (148) Significant impact of symptom severity on health status in patients with fibromyalgia X Luo, J Cappelleri, and A Chandran; Pfizer, New London, CT The health status of patients with fibromyalgia is worse than healthy controls and patients with other chronic diseases as indicated by significantly lower scores on the EuroQol (EQ-5D) index (United States [U.S.] version range -0.109 to 1.0, where 0.0=death and 1.0=perfect health). The objective of this analysis was to identify clinical predictors of the EQ-5D that may be modified in order to improve the health status of patients with fibromyalgia. With adjustment for age and gender, a mean EQ-5D index score of 0.56 was estimated among patients in the U.S. Fibromyalgia Burden of Illness Survey (n=203; 94.6% female; mean [SD] age of 47.9 [16.0] years) using U.S. preference weights. Demographic and clinical factors identified as contributing to the EQ-5D score in simple regression analysis (P<0.05) were then included in a multiple regression analysis. Among clinical variables, the number of tender points was not predictive in the multiple regression model, nor was duration of fibromyalgia. Patient self-reported fibromyalgia symptom severity was a significant predictor of EQ5D score in the multiple regression model. Compared with those reporting ‘‘very severe,’’ patients with ‘‘moderate,’’ ‘‘ mild,’’ and ‘‘very mild’’ symptoms had significantly (p < 0.05) higher (better) mean EQ-5D scores with adjusted differences of 0.19, 0.27, and 0.44 respectively, all of which exceed the clinically important difference of 0.07 that has been estimated for the EQ-5D. In the multiple regression model, major depressive disorder was a significant predictor; the presence of anxiety, cognitive dysfunction, and chronic fatigue syndrome were not. In addition to the clinical predictors, employment status was a significant predictor in the multiple regression model. Based on these results, self-reported symptom severity was identified as a significant predictor of EQ-5D-assessed health status in fibromyalgia patients. Effective management of symptoms will help improve the health status of these individuals. Funded by Pfizer, Inc.
The Journal of Pain
P13
(150) Pain, depression, and sleep difficulties in adolescents E Law, C Murray, L Dufton, and T Palermo; Seattle Children’s Hospital, Seattle, WA Adolescents with chronic pain frequently report sleep difficulties. However, there is a paucity of research on psychological factors that may contribute to the interrelationships between pain and sleep. Strong evidence suggests that depressive symptoms and sleep are related. Thus, this study aimed to compare sleep patterns in three groups of adolescents (chronic pain, depression, and healthy) using objective and subjective sleep measures. Sixty-one adolescents from a pain clinic were compared to 41 youth from an outpatient depression treatment program and 60 youth from the community (mean age = 15.07; 69% female). Participants underwent 10 days of actigraphic sleep monitoring to assess sleep duration (minutes of estimated sleep) and sleep efficiency (ratio of estimated sleep time over time spent in bed), and completed questionnaires assessing sleep quality, pain, and depression. MANOVA was used to test group differences on all sleep variables. The three groups differed on actigraphic sleep variables (F(4, 316) = 3.78, p = .005) and sleep quality scores (F(10, 300) = 6.78, p < .001). Adolescents with chronic pain had longer sleep duration, better sleep efficiency, and better sleep quality compared to depressed adolescents (p’s < .001). Compared to their healthy peers, adolescents with chronic pain had poorer sleep quality (p’s < .001) but actigraphic sleep duration and efficiency were similar. Linear regression analysis controlling for age, gender, and body mass index revealed that higher pain frequency (b = -.220, p = .05) and greater depressive symptoms (b = -.449, p = .009) each predicted worse sleep quality. The interaction between pain and depression was not a significant predictor of sleep quality. These findings highlight the interrelationship between pain and sleep and the complex role of depressive symptoms.
A10 Psychological Assessment (149) Emotional regulation and acute pain reactivity in youth J Tsao, L Allen, L Seidman, S Evans, and L Zeltzer; UCLA Pediatric Pain Research Program, Los Angeles, CA Maladaptive emotion regulation (ER), characterized by efforts to suppress, ignore, or hide emotions, or strategies to overcontrol emotions by worrying, obsessing, and catastrophizing has recently been linked to greater acute pain responsivity in adults. Because existing research has not examined such relationships among children, the present study sought to test the association between maladaptive ER and experimental pain reactivity in 36 healthy children and adolescents (mean age = 12.8 years; 21 girls). Participants completed the Emotion Expression Scale for Children (EESC) prior to undergoing the cold pressor task (CPT), an evoked pressure task (EP), and a pressure tolerance task (PT). The EESC contains two subscales: Poor Emotional Awareness (PEA) and Expressive Reluctance (EXR); higher scores indicate more maladaptive ER. Partial correlations controlling for child age were conducted to examine the relationship between the EESC subscales and laboratory pain responses. PEA scores were significantly correlated with anticipatory anxiety, anticipated pain, pain intensity, anxiety during the task and pain bother for all three pain tasks (r’s = .33 - .60, p’s < .05). EXR scores were significantly correlated with anticipatory anxiety, pain intensity, anxiety during the task and pain bother for the CPT (r’s = .36 - .47, p’s < .05), with pain intensity for the EP (r = .48, p < .01) and pain bother for the PT (r = .45, p < .01). PEA scores were also positively correlated with presession heart rate (r = .35, p < .05); EXR scores were positively correlated with post-session systolic blood pressure (r = .34, p < .05) and marginally correlated with post-session heart rate (r = .33, p = .052). These findings are consistent with prior work indicating that impairments in ER contribute to heightened acute pain responses and increased physiological reactivity to stress.
(151) Depression is associated with more functional impairment than distal neuropathic pain in HIV-infected individuals in the era of combination antiretroviral therapy J Keltner, F Vaida, R Ellis, T Moeller-Bertram, D Franklin, C FitzSimons, S Corkran, C FitzSimons, N Duarte, J Robinson-papp, R Dworkin, D Clifford, B Gelman, D Simpson, J McArthur, A Mccuthan, A Collier, C Marra, S Morgello, J Atkinson, and I Grant; University of California, San Diego, San Diego, CA Distal neuropathic pain (DNP) and depression are prevalent in HIV but their relative impacts on functional impairment are unclear. A better understanding of pain-depression relationships may help identify target populations for intensive treatment. In the multi-site CNS HIV Antiretroviral Treatment Effects Research (CHARTER) study of HIV infected patients (N = 1434) attending 6 university-based clinics, we examined the relationships between DNP, depression (Beck Depression Inventory, BDI), and seven measures of functional impairment (Medical Outcomes Study-HIV, MOS-HIV) in the entire cohort (N=1434), and in the subset with DNP (N=420). Linear regression analysis was used to investigate the separate dependencies of functional impairment upon DNP and upon BDI; while cluster analysis (K-Means, Ward Hierarchical) was used to investigate the dependencies of functional impairment upon both DNP and BDI. For both samples the regression R2 between the seven functional measures vs DNP were .00-.20 while vs BDI were .11-.64. R2 was higher vs BDI than vs DNP for all functional measures and statistically different for 6/7 functional subscales (P<.00015). For both samples the cluster identification overlap for KM and WH cluster techniques was 74-100%. Clusters for the entire cohort were no DNP/low BDI, no DNP/high BDI , high DNP/moderate BDI. Those for the pain subset were low DNP/low BDI, high DNP/moderate BDI, moderate DNP/ high BDI. In the entire cohort worst functional scores aggregated in the no DNP/high BDI cluster. In the pain population worst function occurred with moderate DNP/high BDI cluster. These results suggest that although some DNP patients appear to cope well and maintain function, detection and treatment of depression in specific subsets (moderate DNP/high BDI) may be crucial to successful management of impairment.
The Journal of Pain
P13
(150) Pain, depression, and sleep difficulties in adolescents E Law, C Murray, L Dufton, and T Palermo; Seattle Children’s Hospital, Seattle, WA Adolescents with chronic pain frequently report sleep difficulties. However, there is a paucity of research on psychological factors that may contribute to the interrelationships between pain and sleep. Strong evidence suggests that depressive symptoms and sleep are related. Thus, this study aimed to compare sleep patterns in three groups of adolescents (chronic pain, depression, and healthy) using objective and subjective sleep measures. Sixty-one adolescents from a pain clinic were compared to 41 youth from an outpatient depression treatment program and 60 youth from the community (mean age = 15.07; 69% female). Participants underwent 10 days of actigraphic sleep monitoring to assess sleep duration (minutes of estimated sleep) and sleep efficiency (ratio of estimated sleep time over time spent in bed), and completed questionnaires assessing sleep quality, pain, and depression. MANOVA was used to test group differences on all sleep variables. The three groups differed on actigraphic sleep variables (F(4, 316) = 3.78, p = .005) and sleep quality scores (F(10, 300) = 6.78, p < .001). Adolescents with chronic pain had longer sleep duration, better sleep efficiency, and better sleep quality compared to depressed adolescents (p’s < .001). Compared to their healthy peers, adolescents with chronic pain had poorer sleep quality (p’s < .001) but actigraphic sleep duration and efficiency were similar. Linear regression analysis controlling for age, gender, and body mass index revealed that higher pain frequency (b = -.220, p = .05) and greater depressive symptoms (b = -.449, p = .009) each predicted worse sleep quality. The interaction between pain and depression was not a significant predictor of sleep quality. These findings highlight the interrelationship between pain and sleep and the complex role of depressive symptoms.
A10 Psychological Assessment (149) Emotional regulation and acute pain reactivity in youth J Tsao, L Allen, L Seidman, S Evans, and L Zeltzer; UCLA Pediatric Pain Research Program, Los Angeles, CA Maladaptive emotion regulation (ER), characterized by efforts to suppress, ignore, or hide emotions, or strategies to overcontrol emotions by worrying, obsessing, and catastrophizing has recently been linked to greater acute pain responsivity in adults. Because existing research has not examined such relationships among children, the present study sought to test the association between maladaptive ER and experimental pain reactivity in 36 healthy children and adolescents (mean age = 12.8 years; 21 girls). Participants completed the Emotion Expression Scale for Children (EESC) prior to undergoing the cold pressor task (CPT), an evoked pressure task (EP), and a pressure tolerance task (PT). The EESC contains two subscales: Poor Emotional Awareness (PEA) and Expressive Reluctance (EXR); higher scores indicate more maladaptive ER. Partial correlations controlling for child age were conducted to examine the relationship between the EESC subscales and laboratory pain responses. PEA scores were significantly correlated with anticipatory anxiety, anticipated pain, pain intensity, anxiety during the task and pain bother for all three pain tasks (r’s = .33 - .60, p’s < .05). EXR scores were significantly correlated with anticipatory anxiety, pain intensity, anxiety during the task and pain bother for the CPT (r’s = .36 - .47, p’s < .05), with pain intensity for the EP (r = .48, p < .01) and pain bother for the PT (r = .45, p < .01). PEA scores were also positively correlated with presession heart rate (r = .35, p < .05); EXR scores were positively correlated with post-session systolic blood pressure (r = .34, p < .05) and marginally correlated with post-session heart rate (r = .33, p = .052). These findings are consistent with prior work indicating that impairments in ER contribute to heightened acute pain responses and increased physiological reactivity to stress.
(151) Depression is associated with more functional impairment than distal neuropathic pain in HIV-infected individuals in the era of combination antiretroviral therapy J Keltner, F Vaida, R Ellis, T Moeller-Bertram, D Franklin, C FitzSimons, S Corkran, C FitzSimons, N Duarte, J Robinson-papp, R Dworkin, D Clifford, B Gelman, D Simpson, J McArthur, A Mccuthan, A Collier, C Marra, S Morgello, J Atkinson, and I Grant; University of California, San Diego, San Diego, CA Distal neuropathic pain (DNP) and depression are prevalent in HIV but their relative impacts on functional impairment are unclear. A better understanding of pain-depression relationships may help identify target populations for intensive treatment. In the multi-site CNS HIV Antiretroviral Treatment Effects Research (CHARTER) study of HIV infected patients (N = 1434) attending 6 university-based clinics, we examined the relationships between DNP, depression (Beck Depression Inventory, BDI), and seven measures of functional impairment (Medical Outcomes Study-HIV, MOS-HIV) in the entire cohort (N=1434), and in the subset with DNP (N=420). Linear regression analysis was used to investigate the separate dependencies of functional impairment upon DNP and upon BDI; while cluster analysis (K-Means, Ward Hierarchical) was used to investigate the dependencies of functional impairment upon both DNP and BDI. For both samples the regression R2 between the seven functional measures vs DNP were .00-.20 while vs BDI were .11-.64. R2 was higher vs BDI than vs DNP for all functional measures and statistically different for 6/7 functional subscales (P<.00015). For both samples the cluster identification overlap for KM and WH cluster techniques was 74-100%. Clusters for the entire cohort were no DNP/low BDI, no DNP/high BDI , high DNP/moderate BDI. Those for the pain subset were low DNP/low BDI, high DNP/moderate BDI, moderate DNP/ high BDI. In the entire cohort worst functional scores aggregated in the no DNP/high BDI cluster. In the pain population worst function occurred with moderate DNP/high BDI cluster. These results suggest that although some DNP patients appear to cope well and maintain function, detection and treatment of depression in specific subsets (moderate DNP/high BDI) may be crucial to successful management of impairment.