The Effect of Pain Treatment on Fatigue and Sleep Quality in Children and Adolescents - A Longitudinal Study.

Objectives: Fatigue and poor sleep quality are common comorbidities in pediatric chronic pain patients and closely related to pain characteristics. Little is known about whether fatigue and sleep quality change after pain therapy or whether there are differences between various treatment intensities.

Methods: In a longitudinal study with three measurement points (T1 - before therapy, T2 - 3 mo after therapy, T3 - 6 mo after therapy), n=248 outpatient and n=338 inpatient youth (11-17 y; 73.4% female) receiving pain therapy (single outpatient consultation for outpatient youth vs. intensive interdisciplinary pain treatment for inpatient youth) at two different pain centers were studied. We examined the prevalence of fatigue and poor sleep quality in out- versus inpatient youth, as well as the longitudinal relationships between fatigue, sleep quality, and pain variables. Changes in fatigue and sleep quality over the course of pain therapy in out- and inpatient youth were also explored.

Results: Fatigue was highly prevalent, particularly among inpatient youth, with 44% experiencing moderate or severe fatigue symptoms. There were significant correlations between fatigue, sleep quality, and pain-related factors such as pain intensity, functional impairment, and pain-related missed school days. Fatigue symptoms and sleep quality worsened in inpatient youth but partially improved in outpatient youth from pre- to post-therapy.

Discussion: Fatigue and sleep are relevant comorbidities in youth living with chronic pain. Addressing these issues should become an established goal of pediatric pain management, as it might further improve pain outcomes. This may require complementary interventions to explicitly target these comorbidities.