Sleep, Pain Catastrophizing, and Pain Intensity in Treatment Seeking Adults With Opioid Use Disorder.

Objectives: Opioid use disorder (OUD) is a large, growing, and difficult-to-treat problem. It has been associated with poor sleep, which has a relationship of mutual exacerbation with pain. These interrelationships have prompted interest in how pain catastrophizing (pain-related distortions of cognition), interacts with pain and sleep quality and quantity in those with OUD.

Methods: Participants with chronic pain and OUD (N = 105) completed a battery of self-report assessments. A subset of these participants (N = 63) wore an actigraphy watch for 2 weeks. Six mediation models were evaluated in this cross-sectional study interrelating pain intensity, pain catastrophizing, and sleep in previously published work were run 3 times each, measuring global sleep quality through the Pittsburgh Sleep Quality Index, self-reported total sleep time (TST) through Pittsburgh Sleep Quality Index, and objective TST through actigraphy.

Results: Three models yielded statistically significant results: (1) the relationship between global sleep quality and pain intensity mediated by pain catastrophizing (z = -2.00, P = 0.045), (2) the relationship between objective TST and pain intensity mediated by pain catastrophizing (z = -2.15, P = 0.032), and (3) the relationship between pain intensity and objective TST mediated by pain catastrophizing (z = -2.36, P = 0.018).

Conclusion: Pain catastrophizing is a significant mediator of the relationship between the mutually exacerbating factors of sleep quality and pain intensity, and is, therefore, an important treatment target in this population. In addition, objective TST and self-reported TST were only moderately correlated and behaved differently in mediation models, suggesting that more research is needed to understand the relationship between perceived sleep quality and sleep quantity.