Poor Sleep Quality Mediates Relationship Between Stress, Chronic Pain

Using melatonin in children with neurodevelopmental problems
Using melatonin in children with neurodevelopmental problems
In pediatric patients, poor sleep quality partially mediates PTSS and chronic pain relationships.

Poor sleep quality partially mediates relationships between post-traumatic stress syndrome (PTSS) and severity of chronic pain in pediatric patients, according to a study published in the Journal of Pain.

In this study, investigators assessed sleep quality and its associative impact on PTSS and chronic pain among 97 patients between 10 and 17 years old. Pain intensity was evaluated using the 11-point Numerical Rating Scale, PTSS severity was assessed with the 27-item Child Post-Traumatic Stress Disorder Symptom Scale, and sleep quality was evaluated using the subjective 10-item Revised Adolescent Sleep-Wake Scale.

Overall, patients with a diagnoses of anxiety and depression showed higher PTSS severity than patients without mood disorders (P =.024). In addition, researchers found that low vs normal sleep quality was associated with high PTSS severity and with higher pain intensity and pain interference.

Investigators determined that sleep represented a partial mediator between pain intensity and PTSS, an association that remained statistically significant after controlling for mood disorders (PE =.008, SE =0.005; CIBca, 0.001-0.019). In addition, quality of the participant’s sleep was also found to be a partial mediator between pain interference and PTSS (PE =.052, SE =0.025; CIBCa, 0.015-0.114).

Although this study did not assess the neurobiologic mechanism behind poor sleep quality and PTSS/pain intensity, the researchers hypothesize that low-quality sleep may decrease dopamine levels, an occurrence that is commonly observed in patients with chronic pain.

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According to the investigators, the findings demonstrate that chronic pain treatment might potentially target sleep quality, ultimately modifying “a trajectory of pain and comorbid mental health problems from persisting into adulthood.”


Noel M, Vinall J, Tomfohr-Madsen L, Holley AL, Wilson AC, Palermo TM. Sleep mediates the association between PTSD symptoms and chronic pain in youth [published online September 26, 2017]. J Pain. doi:10.1016/j.jpain.2017.09.002

This article originally appeared on Clinical Pain Advisor