Role of sleep deficiency in self-management of pediatric chronic pain

项目摘要 5%到8%的年轻人报告说有严重的慢性疼痛和残疾。睡眠不足，包括数量减少和 据估计，在患有慢性疼痛的年轻人中，睡眠质量问题很常见，而且高度并存。沉睡 缺乏会导致更大的残疾、更差的生活质量和更多的卫生保健使用。历史上的 童年慢性疼痛使青少年面临终身疼痛和残疾的风险以及高度的医疗保健 成人期的代价。因此，找到有效的方法来支持年轻人自我管理疼痛是一种 优先考虑。尽管在为青年建立疼痛自我管理干预措施方面取得了进展， 治疗产生了小到中等的效果，患者的反应有很大的差异。我们的 初步数据显示，睡眠不足程度较高的青少年自我管理疼痛干预较少 可以接受，在与疼痛相关的结果中收获较少，这表明睡眠可能代表着被忽视的 影响青少年自我管理能力的健康因素。睡眠和疼痛是一种双向关系，而且 数据表明，睡眠不足会增加成人和儿童对疼痛的敏感度。除了直接 睡眠对疼痛的影响，睡眠不足与许多可能影响自我的区域有关 管理技能，包括复杂认知功能的缺陷和自我调节能力的降低。 然而，到目前为止，还没有研究确定睡眠不足对儿童自我管理的影响 慢性疼痛。因此，这项应用的目标是描述睡眠不足如何影响 青年参与、实施和受益于疼痛自我管理干预的能力。我们会研究 一个由80名年轻人组成的队列，年龄在12岁到17岁之间，患有慢性肌肉骨骼、头部或腹部疼痛。 评估将在基线时进行，干预后立即进行，并在干预后3个月重复。 调解人将在额外的中期治疗(4周)数据点进行评估。所有青年都将获得 在为期8周的时间里，通过互联网进行疼痛自我管理干预。遵循建议的 用于自我管理的公共数据元素我们衡量三个自我管理流程，包括患者 激活、疼痛自我效能和自我管理技能，并评估患者报告的健康结果 (全球健康、疲劳)和疼痛(疼痛症状、与疼痛相关的残疾)。积极和消极的影响将是 被评估为潜在的调解人。睡眠不足将用主观综合评估 测量、每日睡眠记录和动态动态监测，以测量睡眠中断、 睡眠、睡眠质量和失眠症状。通过确定睡眠不足对年轻人能力的影响 参与并获得疼痛自我管理技能，我们将获得开发定制的 在随后的R01中为患有慢性疼痛和睡眠不足的青少年制定自我管理计划 使用大规模随机对照试验。

Project Summary 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, and there is tremendous variability in patient response. 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. Following the recommended Common Data Elements for self-management we measure three self-management processes including patient activation, pain self-efficacy, and self-management skills, and assess patient-reported outcomes of health (global health, fatigue) and pain (pain symptoms, pain-related disability). Positive and negative affect will be assessed as potential mediators. Sleep deficiency will be comprehensively assessed with subjective measures, daily sleep logs, and ambulatory actigraphy monitoring to measure disrupted sleep, amount of sleep, sleep quality, and insomnia symptoms. By identifying the effects of sleep deficiency on youth’s ability to engage with and acquire pain self-management skills, we will gain novel insight needed to develop a tailored self-management program for youth with comorbid chronic pain and sleep deficiency in a subsequent R01 using a large-scale RCT.