Annual Meeting Research Awards

Exploring Sleep Disparities in Youth with Chronic Pain

By Franchesca M. Rivera-Calonje, MD; Eugene Kim, MD; Alvina Rosales, PhD
Division of Pain Medicine
Children’s Hospital Los Angeles
Keck School of Medicine
University of Southern California
Los Angeles, California

Approximately one in five children and adolescents experience chronic pain. Over half of youth with chronic pain experience sleep disturbances that can amplify pain and affect daily function, mood, and health related quality of life. The study’s objective was to explore sleep disparities in youth with chronic pain. The primary aim of this study was to examine the role of socioeconomic status (SES), race, and acculturation on sleep quantity and quality.

Through retrospective, cross-sectional chart review and self-reported questionnaires, we studied youth seen in the Pain Clinic at Children’s Hospital Los Angeles from 2016-2018. We analyzed PROMIS Pediatric Short Form for fatigue and pain intensity in addition to sleep quantity and quality, using total sleep time, sleep onset, night awakenings. Caregiver preferred language (English or Spanish) was used as a proxy variable for acculturation and insurance type (government assisted or commercial) was used as a proxy for SES.

Pearson Correlation analysis found Spanish-speaking caregiver preferred language was associated with higher intensity of pain (r = .289, n = 44, p = < .05) and increased difficulty sleeping when in pain (r = .267, n = 44, p = < .05). No correlation between sleep duration, SES and fatigue were identified. Similarly, ANOVA showed non-Latino white youth had less pain on average compared to black youth (p = < .05). Chi-squared qualitative sleep analysis also identified that youth from Spanish-speaking caregivers were more likely to experience poorer quality of sleep (more night awakenings); X 2 (1, n=43) = 4.3, p< .05.

This study advances our understanding of pediatric pain and identifies health disparities in pain based on acculturation and race. Findings suggest that youth from less acculturated families are at higher risk for more poorly managed pain. These youth are likely children of Latino immigrant or first-generation caregivers who are disproportionally more vulnerable to poorer health access and outcomes.

Providers should be aware of these disparities when identifying and treating youth with chronic pain. Larger scale research studies could help identify those patients at higher risk of having pain and sleep disturbances to develop early treatment and intervention programs.

References

  1. King, S., Chambers, C. T., Huguet, A., MacNevin, R. C., McGrath, P. J., Parker, L., & MacDonald, A. J. (2011). The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain, 152(12), 2729-2738.
  2. Palermo TM, Kiska R. Subjective sleep disturbances in adolescents with chronic pain: relationship to daily functioning and quality of life. J Pain 2005;6:201-207.

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