Behavioral and psychosocial factors associated with insomnia in adolescents with chronic pain

Tonya M. Palermo, Anna C. Wilson, Amy S. Lewandowski, Marisol Toliver-Sokol, Caitlin B. Murray

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


This study aimed to (1) identify differences in sleep behaviors, sleep quality, pre-sleep arousal and prevalence of insomnia symptoms in adolescents with chronic pain compared to a healthy age and sex-matched cohort and (2) examine pain intensity, pubertal development, depression, and pre-sleep arousal as risk factors for insomnia symptoms. Participants included 115 adolescents, 12-18 years of age (73.0% female), 59 youth with chronic pain and 56 healthy youth. During a home-based assessment, adolescents completed validated measures of pain, sleep quality, sleep hygiene, pre-sleep arousal, depressive symptoms, and pubertal development. Findings revealed a significantly higher percentage of adolescents with chronic pain reporting symptoms of insomnia (54.2%) compared to healthy adolescents (19.6%), p < .001. Youth with chronic pain also reported higher cognitive and somatic arousal at bedtime, and lower sleep quality compared to the healthy cohort. In a logistic regression, two factors emerged as significant predictors of insomnia, having chronic pain (OR = 6.09) and higher levels of cognitive pre-sleep arousal (OR = 1.24). Level of pain intensity did not predict insomnia. While sleep disruption may initially relate to pain, these symptoms may persist into a separate primary sleep disorder over time due to other behavioral and psychosocial factors. Assessment of insomnia may be important for identifying behavioral targets for the delivery of sleep-specific interventions to youth with chronic pain.

Original languageEnglish (US)
Pages (from-to)89-94
Number of pages6
Issue number1
StatePublished - Jan 2011


  • Adolescent
  • Chronic pain
  • Depression
  • Insomnia
  • Sleep

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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