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

项目摘要 5%到8%的年轻人报告严重的慢性疼痛和残疾。睡眠不足，包括数量减少， 睡眠质量，在估计50%患有慢性疼痛的青年中是常见的和高度共病的。睡眠 缺乏会导致更严重的残疾，更差的生活质量和更多的医疗保健使用。史 儿童期慢性疼痛使青少年面临终身疼痛和残疾以及高医疗保健的风险 成年的代价因此，找到有效的方法，支持青年在自我管理的痛苦是一个 要务虽然在建立青年疼痛自我管理干预措施方面取得了进展， 治疗产生小到中等的效应量，并且患者的反应存在巨大的可变性。我们 初步数据表明，睡眠不足的年轻人发现疼痛自我管理干预较少 可接受的，在疼痛相关的结果中获得的收益较少，这表明睡眠可能是一个被忽视的 影响青少年自我管理能力健康因素。睡眠和疼痛有着双向的关系， 数据表明，睡眠不足会增加成人和儿童的疼痛敏感性。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领域有关。 管理技能，包括复杂认知功能的缺陷和自我调节技能的降低。 然而，到目前为止，研究还没有确定睡眠不足对儿童自我管理的影响。 慢性疼痛因此，本申请的目的是表征睡眠不足如何影响 青少年参与、实施疼痛自我管理干预并从中受益的能力。我们将研究 一组80名年龄在12到17岁之间的年轻人，患有慢性肌肉骨骼、头部或腹部疼痛。 评估将在基线、干预后立即进行，并在干预后3个月重复进行。 将在额外的治疗中期（4周）数据点评估中介。所有的年轻人都会得到一个 通过互联网进行疼痛自我管理干预，为期8周。按照推荐的 自我管理的常见数据元素我们测量三个自我管理过程，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，疼痛相关残疾）。积极和消极的影响将是 作为潜在的调解人。睡眠不足将通过主观评估进行全面评估。 测量，每日睡眠日志和动态活动监测，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共病的青少年提供自我管理计划 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.