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

睡眠不足在小儿慢性疼痛自我管理中的作用

• 批准号: 9789981
• 负责人: Tonya M Palermo
• 金额: $ 18.85万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-21 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789981
• 关键词: Abdominal Pain; Address; Adult; Affect; Affective; Aftercare; Age; Area; Behavioral; Child; Childhood; Chronic Disease; Common Data Element; Comorbidity; Complex; Data; Effectiveness; Fatigue; Goals; Headache; Health; Health Care Costs; Healthcare; Internet; Interruption; Intervention; Measures; Mediating; Mediator of activation protein; Memory; Methods; Monitor; Neurobiology; Outcome; Pain; Patient Outcomes Assessments; Patients; Pattern; Perception; Population; Populations at Risk; Problem Solving; Process; Quality of life; Recording of previous events; Reporting; Research; Risk; Role; Self Efficacy; Self Management; Sleep; Sleep Deprivation; Sleep disturbances; Sleeplessness; Societies; Symptoms; Time; Youth; actigraphy; behavior change; chronic musculoskeletal pain; chronic pain; cognitive function; cohort; cost; disability; executive function; global health; insight; negative affect; novel; pain outcome; pain self-management; pain sensitivity; pain symptom; patient response; post intervention; programs; self-management program; skills; sleep onset; sleep quality

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.

项目概要 5% 至 8% 的青少年报告严重的慢性疼痛和残疾，包括睡眠时间减少和睡眠不足。 睡眠质量的影响在估计 50% 患有慢性疼痛的青少年中很常见且高度共病。 缺乏会导致更大的残疾、更差的生活质量以及增加医疗保健的使用。 儿童慢性疼痛使青少年面临终生疼痛和残疾以及高医疗保健的风险 因此，寻找支持青少年自我管理疼痛的有效方法是一项艰巨的任务。 尽管在建立青少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果，并且患者反应存在巨大差异。 初步数据表明，睡眠不足程度较高的青少年发现疼痛自我管理干预较少 可以接受，并且在与疼痛相关的结果方面取得的进展较少，这表明睡眠可能是一个被忽视的因素 影响青少年自我管理技能的健康因素睡眠和疼痛具有双向关系。 数据表明，睡眠不足会增加成人和儿童的疼痛敏感性。 睡眠对疼痛的影响，睡眠不足与许多可能影响自我感觉的领域有关。 管理技能，包括复杂认知功能缺陷和自我调节能力下降。 然而，迄今为止，研究尚未确定睡眠不足对儿科自我管理的影响 因此，本应用的目的是表征睡眠不足如何影响。 我们将研究青少年参与、实施疼痛自我管理干预措施并从中受益的能力。 一组 80 名年龄在 12 至 17 岁之间的年轻人，患有慢性肌肉骨骼、头部或腹部疼痛。 评估将在基线时、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）数据点对调解员进行评估。所有青少年都将收到一份报告。 按照建议，在 8 周内通过互联网提供疼痛自我管理干预。 自我管理的通用数据元素我们测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 （整体健康、疲劳）和疼痛（疼痛症状、与疼痛相关的残疾）将产生积极和消极的影响。 睡眠不足将通过主观综合评估。 测量、每日睡眠日志和动态体动记录监测，以测量睡眠中断、睡眠量 通过确定睡眠不足对青少年睡眠能力的影响，研究睡眠、睡眠质量和失眠症状。 参与并获得疼痛自我管理技能，我们将获得开发量身定制的疼痛自我管理技能所需的新颖见解 在随后的 R01 中针对患有慢性疼痛和睡眠不足的青少年的自我管理计划 使用大规模随机对照试验。