title: Exploring the associations shared by mood, pain-related attention and pain outcomes related to sleep disturbance in a chronic pain sample.
abstract: Sleep disturbance in chronic pain is common, occurring in two-thirds of patients. There is a complex relationship between chronic pain and sleep; pain can disrupt sleep and poor sleep can exaggerate pain intensity. This may have an impact on both depressive symptoms and attention to pain. This study aims to evaluate the relationship between chronic pain and sleep, and the role of mood and attention.
  
  
  
  Chronic pain patients, recruited from a secondary care outpatient clinic, completed self-report measures of pain, sleep, depressive symptoms and attention to pain. Hierarchical regression and structural equation modelling were used to explore the relationships between these measures. Participants (n = 221) were aged between 20 and 84 (mean = 52) years.
  
  
  
  The majority of participants were found to be 'poor sleepers' (86%) with increased pain severity, depressive symptoms and attention to pain. Both analytical approaches indicated that sleep disturbance is indirectly associated with increased pain severity Instead the relationship shared by sleep disturbance and pain severity was further associated with depressive symptoms and attention to pain.
  
  
  
  Our results indicate that sleep disturbance may contribute to clinical pain severity indirectly though changes in mood and attention. Prospective studies exploring lagged associations between these constructs could have critical information relevant to the treatment of chronic pain.
authors.affiliation: a School of Social and Community Medicine , University of Bristol , Bristol , UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Harrison
authors.affiliation: b Centre for Neuropsychopharmacology, Division of Brain Sciences , Imperial College London , London , UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Wilson
authors.affiliation: a School of Social and Community Medicine , University of Bristol , Bristol , UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Heron
authors.affiliation: c Macmillan Centre , Frenchay Hospital , Bristol , UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Stannard
authors.affiliation: d MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology , University of Bristol , Bristol , UK.
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Munafò
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D059350:Chronic Pain / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D003863:Depression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D057566:Self Report; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: attention; chronic pain; depression; psychology; sleep