Blågestad, Tone, Pallesen, Ståle, Grønli, Janne, Tang, Nicole K. Y. and Nordhus, Inger H. (2016) How perceived pain influence sleep and mood more than the reverse : a novel, exploratory study with patients awaiting total hip arthroplasty. Frontiers in Psychology, 7 . doi:10.3389/fpsyg.2016.01689 ISSN 1664-1078.

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Abstract

Objectives: Attributions about how comorbid symptoms worsen or improve each other are central cognitive components of chronic pain that are shown to facilitate or impede the recovery process. Still, these attributions have been poorly illuminated in chronic pain patients. The present study explored perceptions of how sleep, pain, and mood influence each other in patients awaiting total hip arthroplasty (THA).

Design and Methods: In this cross-sectional study, 291 patients (mean age 67.8, 65.3% female) rated 12 statements about how much a given symptom (pain, sleep, mood) changed when another symptom (pain, sleep, mood) worsened or improved on a response scale ranging from much worse (-2) via no change (0) to much better (2). Sleep (Bergen Insomnia Scale), pain (McGill Pain Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale) were assessed as background variables.

Results: Of the patients in the study, 56% reported symptoms indicating insomnia. Anxiety and depression were indicated in 16 and 10%, respectively. Over 80% rated their pain as horrible/unbearable and reported that pain occurred always/daily. When experiencing increased pain, a majority perceived that sleep (90%) and mood (70%) worsened, whilst experiencing reduced pain improved sleep and mood in 50%. Poor sleep increased pain and worsened mood in 45 and 60% of the patients, respectively. Better sleep was perceived to reduce pain and improve mood in 50%. Worsened mood increased pain (46%) and worsened sleep (52%). Improved mood decreased pain and improved sleep in 25 and 35%, respectively.

Discussion: In this study, a novel approach was used to investigate perceptions of reciprocal relationships between symptoms. We found that THA patients perceived interrelationships between pain, sleep and mood. These perceived interrelations were stronger when symptoms worsened than when symptoms improved. They also held stronger beliefs about the effect of pain on sleep and mood, than the effect of sleep and mood on pain. Attributions are central in illness perception and ultimately affect illness behavior. For patients who perceive symptoms to interrelate, the door has already been opened to utilize these attributions in treatments aiming to disrupt vicious cycles, hence supporting the use of multimodal treatments.

Item Type:	Journal Article
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RD Surgery
Divisions:	Faculty of Science, Engineering and Medicine > Science > Psychology
Library of Congress Subject Headings (LCSH):	Sleep , Total hip replacement , Chronic pain, Mood (Psychology)
Journal or Publication Title:	Frontiers in Psychology
Publisher:	Frontiers Research Foundation
ISSN:	1664-1078
Official Date:	28 October 2016
Dates:	Date Event 28 October 2016 Published 13 October 2016 Accepted 4 July 2016 Submitted
Volume:	7
DOI:	10.3389/fpsyg.2016.01689
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	3 November 2016
Date of first compliant Open Access:	4 November 2016
Funder:	Kavli Foundation
Grant number:	Grant number 808014

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