• Maria Pavlova, Jennifer Ference, Megan Hancock, and Melanie Noel.
• Department of Psychology, University of Calgary, Calgary, AB, Canada.
• Pain Res Manag. 2017 Jan 1; 2017: 1586921.

BackgroundPediatric chronic pain often emerges in adolescence and cooccurs with internalizing mental health issues and sleep impairments. Emerging evidence suggests that sleep problems may precede the onset of chronic pain as well as anxiety and depression. Studies conducted in pediatric populations with pain-related chronic illnesses suggest that internalizing mental health symptoms may mediate the sleep-pain relationship; however, this has not been examined in youth with primary pain disorders.ObjectiveTo examine whether anxiety and depressive symptoms mediated relationships between sleep quality and pain outcomes among youth with chronic pain.MethodsParticipants included 147 youth (66.7% female) aged 8-18 years who were referred to a tertiary-level chronic pain program. At intake, the youth completed psychometrically sound measures of sleep quality, pain intensity, pain interference, and anxiety and depressive symptoms.ResultsAs hypothesized, poor sleep quality was associated with increased pain intensity and pain interference, and anxiety and depressive symptoms mediated these sleep-pain relationships.DiscussionFor youth with chronic pain, poor sleep quality may worsen pain through alterations in mood and anxiety; however, prospective research using objective measures is needed. Future research should examine whether targeting sleep and internalizing mental health symptoms in treatments improve pain outcomes in these youth.

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