Whibley, Daniel, AlKandari, Nourah, Kristensen, Kaja, Barnish, Max, Rzewuska, Magdalena, Druce, Katie L. and Tang, Nicole K. Y. (2019) Sleep and pain : a systematic review of studies of mediation. Clinical Journal of Pain . doi:10.1097/AJP.0000000000000697 (In Press)

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Abstract

Objectives

A relationship between sleep and pain is well established. A better understanding of the mechanisms that link sleep and pain intensity is urgently needed to optimise pain management interventions. The objective of this systematic review was to identify, synthesise and critically appraise studies that have investigated putative mediators on the path between sleep and pain intensity.

Methods

A systematic search of five electronic bibliographic databases (EMBASE, MEDLINE, CINAHL, PsycINFO and the Cochrane Central Register of Controlled Trials) was conducted. Eligible studies had to apply a formal test of mediation to variables on the path between a sleep variable and pain intensity or vice versa. All searches, data extraction and quality assessment were conducted by at least two independent reviewers.

Results

The search yielded 2,839 unique articles, nine of which were eligible. Of 13 mediation analyses, 11 investigated pathways from a sleep variable to pain intensity. Putative mediators included affect/mood, depression and/or anxiety, attention to pain, pain helplessness, stress, fatigue, and physical activity. Two analyses investigated pathways from pain intensity to a sleep variable, examining the potentially mediating role of depressive symptoms and mood. While evidence supported a mediating role for psychological and physiological aspects of emotional experiences and attentional processes, methodological limitations were common, including use of cross-sectional data and minimal adjustment for potential confounders.

Discussion

A growing body of research is applying mediation analysis to elucidate mechanistic pathways between sleep and pain intensity. Currently sparse evidence would be illuminated by more intensively collected longitudinal data and improvements in analysis.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RB Pathology
Divisions:	Faculty of Science > Psychology
Library of Congress Subject Headings (LCSH):	Sleep, Pain -- Treatment
Journal or Publication Title:	Clinical Journal of Pain
Publisher:	Lippincott Williams & Wilkins
ISSN:	0749-8047
Official Date:	28 February 2019
Dates:	Date Event 28 February 2019 Available 19 February 2019 Accepted
Date of first compliant deposit:	28 February 2019
DOI:	10.1097/AJP.0000000000000697
Status:	Peer Reviewed
Publication Status:	In Press
Publisher Statement:	"This is a non-final version of an article published in final form in (provide complete journal citation). "
Access rights to Published version:	Restricted or Subscription Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Versus Arthritis UNSPECIFIED
Related URLs:	Publisher

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