Pain Catastrophizing Mediates the Relationship Between Pain Intensity and Sleep Disturbances in U.S. Veterans with Chronic Pain


This study sought to understand the relationship between chronic pain, sleep quality and sleep duration. The study recruited 184 U.S. Armed Forces Veterans receiving health care services through the Veterans Administration Puget Sound Health Care System (VAPSHCS). The study found that self-reported sleep disturbance and average pain intensity were related. Disturbed sleep was associated with higher levels of pain catastrophizing and greater average pain intensity.


Introduction Veterans with chronic pain frequently report comorbid disruptions in sleep and psychological dysfunction. The purpose of this study was to investigate whether psychological function variables mediate the sleep–pain relationship. Knowledge regarding such contributing factors can inform the development and optimization of treatments for sleep disturbances and pain. Materials and Methods In an IRB-approved, registered clinical trial, we collected objective sleep data from U.S. military Veterans with chronic pain (N = 184, ages 23-81) using wrist actigraphy for 7 days and self-reported survey data assessing sleep quality, pain intensity, and psychological function (depression, anxiety, post-traumatic stress disorder, and pain catastrophizing). We investigated the associations between objectively measured and self-reported sleep quality and self-reported pain intensity. In addition, using parallel mediation analyses, we examined whether psychological function variables mediated these associations. Results Actigraphy showed suboptimal sleep duration (less than 7 hours) and sleep fragmentation for most participants. Self-reported poor sleep quality and pain intensity were significantly correlated. Pain catastrophizing was found to mediate the association between self-reported sleep quality and pain intensity. Conclusions Sleep disturbances in this sample of Veterans with chronic pain included insufficient sleep, fragmented sleep, and perceived poor sleep quality. Analyses suggest that poor perceived sleep quality and pain intensity are mediated via pain catastrophizing. The finding highlights the potential importance of pain catastrophizing in Veterans with chronic pain. Future longitudinal research is needed to determine the extent to which treatments that reduce pain catastrophizing might also improve both sleep and pain outcomes.

Full Reference

Marian Wilson, PhD, MPH, RN, Lillian Skeiky, MS, Rachael A Muck, BS, Kimberly A Honn, PhD, Rhonda M Williams, PhD, Mark P Jensen, PhD, Hans P A Van Dongen, PhD, Pain Catastrophizing Mediates the Relationship Between Pain Intensity and Sleep Disturbances in U.S. Veterans With Chronic Pain, Military Medicine, 2022;, usac065,