and Perspective This study aimed to: 1) examine trajectories of insomnia symptoms in adolescents with chronic pain compared to their healthy peers, 2) evaluate psychological and behavioral risk factors for longitudinal insomnia symptoms, and 3) evaluate insomnia as a predictor of quality of life, activity limitations, and healthcare utilization over 12 months. Participants included 61 adolescents with chronic pain and 60 youth without chronic pain (12–18 years; 72% female). Questionnaires were completed at enrollment, 6-months, and 12-months, and assessed pain intensity, insomnia symptoms, sleep hygiene, pre-sleep arousal, depression, pubertal status, activity limitations, quality of life, and healthcare utilization. Insomnia symptoms persisted for both groups, and remained higher at all time points for youth with chronic pain. GEE modeling identified three risk factors for longitudinal insomnia symptoms: having chronic pain, poorer sleep hygiene, and higher depressive symptoms. Insomnia symptoms also predicted poorer quality of life over time, and were associated with more frequent healthcare utilization. Findings suggest that sleep problems are persistent and associated with negative impact for youth with chronic pain. Treatment of insomnia symptoms in youth with chronic pain may lead to improvements in quality of life and reductions in healthcare costs. Perspective Insomnia symptoms are persistent over a 12 month period and are associated with negative impact for youth with chronic pain. These findings suggest that treatment of insomnia symptoms in youth with chronic pain may lead to improvements in quality of life and reductions in healthcare costs.

In monitoring for symptoms, nurses need to be aware of the extent to which symptoms are present throughout treatment, as evidenced by these findings that symptom occurrence was significant even prior to receiving a subsequent course of chemotherapy.

Purpose The aim of this review is to examine pain measures for hospitalized children with cognitive impairment who are unable to self-report. Design and Methods Electronic searches to identify published evidence were conducted and studies reviewed. Reported psychometrics and feasibility of the NCCPC-PV, INRS, PPP, and r-FLACC were examined. Conclusions These four measures have established validity and reliability. However, clinical utility findings varied. Practice Implications The r-FLACC has demonstrated feasibility in acute care settings related to ease of use, time requirements, and flexibility regarding caregiver input.

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