Sleep Mediates the Association Between PTSD Symptoms and Chronic Pain in Youth

J Pain. 2018 Jan;19(1):67-75. doi: 10.1016/j.jpain.2017.09.002. Epub 2017 Sep 27.


Symptoms of post-traumatic stress disorder (PTSS) and chronic pain have been shown to co-occur at high rates in adolescents and this co-occurrence is linked to worse pain and quality of life. Sleep disturbance has been posited as a mechanism underlying this co-occurrence in conceptual models of mutual maintenance. This study examined the mediating role of sleep in the relationship between PTSS and pain in youth (aged 10-17 years) with chronic pain. Ninety-seven participants completed measures of PTSS, pain (intensity and interference), anxiety symptoms, and sleep quality, in addition to demographic characteristics. Mediation models were conducted. Findings revealed that, over and above the influence of associated demographic characteristics (age, race) and anxiety symptoms, sleep quality partially mediated the relationships between PTSS and pain intensity and interference for youth with chronic pain. Specifically, higher levels of PTSS was linked to higher levels of pain intensity and pain interference, and these relationships were partially explained by poor sleep quality. Findings highlight the potential mechanistic role of sleep in explaining the co-occurrence of chronic pain and PTSS and suggest sleep might be an important target in future interventions.

Perspective: Consistent with the pediatric model of mutual maintenance in PTSS and chronic pain, poor sleep quality was found to underlie this co-occurrence in youth.

Keywords: Chronic pain; child/adolescent; post-traumatic stress disorder symptoms; sleep; trauma.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Chronic Pain / complications*
  • Chronic Pain / psychology
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Quality of Life
  • Sleep / physiology*
  • Sleep Wake Disorders / etiology*
  • Sleep Wake Disorders / therapy*
  • Stress Disorders, Post-Traumatic / complications*
  • Stress Disorders, Post-Traumatic / psychology
  • Surveys and Questionnaires