Sleep Disturbance and Pain Sensitivity in Chronic Pain

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DESCRIPTION (provided by applicant): This Career Development Award (K23) will provide the candidate the necessary training to establish a program of research to evaluate the causes, consequences, and treatments of sleep disturbance in chronic pain disorders. Chronic pain is a major health problem leading to substantial suffering and economic burden. Sleep disturbance is a prominent and disabling feature of chronic pain disorders. While epidemiologic research has found that sleep disturbance substantially increases the risk of serious medical and psychiatric morbidities, sleep research in chronic pain is quite limited and of poor quality. Experimental research in healthy subjects suggests that the relationship between pain and sleep may be reciprocal, such that pain disturbs sleep and sleep disruption enhances pain sensitivity. This relationship has been inadequately studied in clinical populations and empirical approaches to treatment are lacking. The candidate's educational plan includes mentorship, didactics, and experiences designed to achieve 3 career development objectives: 1) Gain expertise in pain assessment, 2) gain expertise in polysomnography and 3) develop a foundation in clinical trials methods. Expert mentorship on quantitative sensory testing, quantitative EEG, and clinical trials is planned. Didactics include courses in neuroscience, biostatistics, and the conduct of clinical trials. The research plan proposes a prospective study of sleep in patients with chronic myofascial pain associated with temporo-mandibular joint disorder (TMD). This study will: 1) Characterize the nature of sleep disturbance in TMD using self-report, activity monitoring, and polysomnography, 2) evaluate whether the diagnosis of insomnia and/or sleep microstructure abnormalities are associated with decreased pressure pain threshold, and 3) determine whether measures of sleep predict the short-term (2-month) course of pain severity. Based on the results of the longitudinal study and the candidate's training in clinical trial methods, the final award year will include conducting a pilot clinical trial (N=10) to establish the feasibility of a cognitive-behavioral intervention and test the credibility of a suitable placebo intervention for treating sleep disturbance in chronic pain. The candidate's K23 research and training plan will provide a foundation for independent investigation of sleep disturbance as a modifiable risk factor for developing chronic pain and interventions to treat sleep disturbance in chronic pain.