The Concurrent and Temporal Associations Between Pain Self-Efficacy, Sleep Disturbance, and Pain Intensity in...

The objective of this study was to replicate and extend prior evidence regarding the concurrent associations among pain self-efficacy, sleep disturbance, and pain intensity in adults with chronic pain, and to evaluate their temporal associations over time.

This prospective study enrolled 300 Thai chronic pain outpatients from Siriraj Hospital, of whom 50 were excluded due to loss to follow-up, yielding a final sample of 250 participants. Standard questionnaires were administered to assess pain severity, pain self-efficacy, and sleep disturbance at baseline (initial visit) and again at a follow-up assessment conducted about 6 weeks later (range 4-8 weeks). Longitudinal associations were examined using cross-lagged panel models with covariate adjustment, and moderation analyses were conducted using multiple linear regression with interaction terms.

Participants were primarily female with a mean age of 54 years; neuropathic pain was the most common condition. Due to the COVID-19, about half of the participants (52%) did not return to the hospital for follow-up. However, they did return completed follow-up questionnaires via email. The average time between two assessments was 6.25 ± 1.77 weeks. Concurrent associations among pain intensity, sleep disturbance, and pain-related self-efficacy were observed in expected directions (correlations ranging from r's = 0.42 to 0.47). After controlling for age, birth sex, education level, and pain duration, each primary study variable was significantly correlated with its corresponding variable at follow-up (r's = 0.42 to 0.56). The only significant cross-lagged association to emerge was between pain-related self-efficacy at the initial visit and pain intensity at follow-up (β = 0.17, p < 0.01). In unadjusted regression, T1 self-efficacy was negatively associated with T2 pain intensity (β = -0.11, p = 0.08), but the direction reversed and became significant after adjustment (β = 0.18, p < 0.01), indicating a statistical suppression effect.

Medium to large concurrent associations were observed in expected directions between measures of pain severity, pain self-efficacy, and sleep disturbance; each of these measures were also stable over time. Only one significant cross-lagged effect emerged, which may reflect statistical suppression rather than a true adverse temporal effect. The temporal associations between these domains require further longitudinal evaluation.