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.

Attainment of high school diploma ** 0.68 [0.57 -0.82] a,b,d,h Attainment of college / bachelors degree * 0.83 [0.71 -0.96] b,d,f,h Currently employed full time 0.92 [0.82 -1.05] a,c,h Employer-provided benefits * 0.80 [0.69 -0.93] a,c,f,h Work-goal alignment * 0.87 [0.77 -0.98] a,c,f,h Receipt of public assistance ** 1.31 [1.16 -1.48] b,e,g,i Social Living independently 1.09 [0.91 -1.30] a,b,d,f Married or cohabitating 1.14 [0.99 -1.30] a,b,d,g Has biological children ** 1.28 [1.13 -1.45] a,b,e,g,i Continuous outcomes b [SE] Educational/Vocational Age began full-time work * −0.22 [0.07] a,b,f,h Mean income, in US dollars −1108 [1295] a,c,e,f,h Social Romantic relationship quality * −0.08 [0.02] b,d,f,h # of close friends 0.02 [0.03] c,d,f,h Note. * p < .01; ** p < .001. Covariates included sex, age (at Wave IV), race/ethnicity, and parental income. Notations for significant covariates (p < .05

Supplemental Digital Content is Available in the Text. Using a hybrid implementation-effectiveness design, our digital psychological intervention for pediatric chronic pain (WebMAP) demonstrated successful implementation, but effectiveness was limited by modest treatment engagement.

There is limited research describing the patterns of healthcare utilization in adolescents with chronic pain. This study describes healthcare utilization in a clinical chronic pain sample, and compares the patterns of service use of this group to a community sample with intermittent pain complaints. We also investigated demographic and clinical factors that predicted healthcare visits and medication use in the clinical sample. Data on 117 adolescents (aged 12-18; n=59 clinical pain sample, n=58 community) were collected. Caregivers and adolescents reported on sociodemographics, medical visits, current medications, pain, activity limitations, and depression. As hypothesized, the clinical pain sample had higher rates of healthcare consultation on all types of medical visits (general, specialty care, complementary medicine, mental health, OT/PT), and higher medication use compared to the community sample. Regression analyses revealed that higher annual income, greater pain frequency, and higher levels of caregiver reported activity limitations were associated with a greater number of healthcare visits for the total sample. Within the clinical pain sample, higher pain frequency and greater activity limitations (caregiver-report) predicted more specialty care visits. Additionally, higher income and greater levels of depressive symptoms predicted a higher number of prescribed medications.Perspective-This study contributes to the limited available data on health service and medication use in a clinical chronic pain sample versus a community sample of adolescents. We also identify clinical factors (pain frequency, parent-reported activity limitations, depressive symptoms) and demographic factors (gender, income) associated with healthcare utilization.

The RLS-QLI is a valid disease-specific HRQL instrument that will contribute to our understanding of how RLS impacts the lives of those affected with this CNS disorder.