• Dagmar Amtmann, Alyssa M Bamer, Robert Askew, and Mark P Jensen.
• University of Washington, Rehabilitation Medicine, Box 354237, 4907 25th Ave NE, Seattle, WA, 98105, USA. Electronic address: dagmara@uw.edu.
• Disabil Health J. 2020 Jul 1; 13 (3): 100908.

BackgroundThere is substantial evidence that pain intensity and sleep are related, with findings generally suggesting more support for the influence of sleep on pain intensity than vice versa. However, the strength and direction of the relationship has been found to vary among different populations, with few studies in individuals with chronic physical disabilities.ObjectiveExamine the directionality of the sleep and pain relationship in individuals with chronic physical disabilities.MethodsCross-lagged effects models were generated using data from a longitudinal observational survey study of individuals (N = 1660) with multiple sclerosis (MS), muscular dystrophy (MD), post-polio syndrome (PPS), and spinal cord injury (SCI). Models evaluated the correlational effects of sleep disturbance and pain intensity, as well as the cross-lagged effects of sleep disturbance to pain intensity and vice versa.ResultsThe effects of pain on sleep were stronger than sleep on pain, although the magnitude of the effects were both relatively weak. Analyses within individual samples were consistent with the overall sample results for MS, MD, and PPS. In the SCI sample the magnitude and direction of the cross-lagged model paths were more variable than in the other samples.ConclusionsThe relationship between pain intensity and sleep disturbance appears bi-directional, but the effects are small in a sample of individuals with long-term disabilities. The temporal effects of pain on sleep disturbance appear stronger than the effects of sleep disturbance on pain intensity. Future research is needed to better understand this relationship in the context of pain and/or sleep disturbance treatments.Copyright © 2020 Elsevier Inc. All rights reserved.

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