Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity

Abstract

Objective Sleep and pain-related experiences are consistently associated, but the pathways linking these experiences are not well understood. We evaluated whether pain catastrophizing and arthritis self-efficacy mediate the association between sleep disturbance and osteoarthritis (OA) symptom severity in patients with knee OA. Methods We analyzed cross-sectional baseline data collected from Veterans Affairs (VA) patients enrolled in a clinical trial examining the effectiveness of a positive psychology intervention in managing pain from knee OA. Participants indicated how often in the past two weeks they were bothered by trouble falling asleep, staying asleep, or sleeping too much. We used validated scales to assess the primary outcome (OA symptom severity) and potential mediators (arthritis self-efficacy and pain catastrophizing). To test the proposed mediation model, we used parallel multiple mediation analyses with bootstrapping, controlling for sociodemographic and clinical characteristics with bivariate associations with OA symptom severity. Results The sample included 517 patients (Mage = 64 years, 72.9% male, 52.2% African American). On average, participants reported experiencing sleep disturbance at least several days in the past two weeks (M = 1.41, SD = 1.18) and reported moderate OA symptom severity (M = 48.22, SD = 16.36). More frequent sleep disturbance was associated with higher OA symptom severity directly (b = 3.08, P <0.001) and indirectly, through higher pain catastrophizing (b = 0.60, 95% confidence interval [CI] = 0.20 to 1.11) and lower arthritis self-efficacy (b = 0.84, 95% CI = 0.42 to 1.42). Conclusions Pain catastrophizing and arthritis self-efficacy partially mediated the association between sleep disturbance and OA symptom severity. Behavioral interventions that address pain catastrophizing and/or self-efficacy may buffer the association between sleep disturbance and OA symptom severity.

Relationship Between Attitudes and Beliefs About Sleep, Sleep Disturbance, and Pain Interference in Patients With Spinal Pain

“…Catastrophizing thoughts are associated with pain interference, specifically feelings of helplessness, in those experiencing spinal pain 66,67,70. In addition, pain catastrophizing is a mediator of sleep disturbance and symptom severity in those with knee osteoarthritis 71. It is possible that DBAS-16 scores relate to one’s catastrophizing thoughts in general, which may also influence pain interference.…”

Relación de las variables de catastrofismo y autoeficacia con la intensidad del dolor, la función y la discapacidad en pacientes de artrosis de rodilla y cadera: una revisión sistemática

“…Sin embargo, la sintomatología de la artrosis parece tener también otros mediadores importantes, como son los factores psicológicos: en el estudio de Helminen et al, (2020), la ansiedad, la autoeficacia, el catastrofismo y las creencias de miedo y evitación a nivel basal predijeron los niveles de dolor y función a los 5 años de seguimiento (Helminen et al, 2020). Además, el catastrofismo parece influir en la relación entre el género y las variables de dolor en artrosis de rodilla, y, junto a la autoeficacia, median parcialmente la asociación entre las alteraciones en el sueño y la severidad de dolor de la artrosis (Keefe et al, 2000;Tighe et al, 2020).…”

“…Estas variables podrían perjudicar el pronóstico de los pacientes de dolor crónico, perpetuando sus efectos negativos en el tiempo. Algunas de las variables más relevantes en la perpetuación del dolor y otros trastornos asociados en artrosis son el catastrofismo y la autoeficacia (Tighe et al, 2020).…”

Sleep Disturbances and Disorders in Patients with Knee Osteoarthritis and Total Knee Arthroplasty

“…Given the high rate of sleep disturbances and disorders among patients with knee osteoarthritis and those undergoing TKA, it is important for the practicing arthroplasty surgeon to have an understanding of these topics [13][14][15] . The purpose of this review was to provide a primer on sleep physiology and normal sleep architecture, define the most common sleep disorders that affect TKA patients, and review the current literature on the management of sleep apnea and sleep disturbance after TKA.…”

“…Sleep is an important physiologic process involved in both physical and mental health. Sleep disturbances or diagnosis of a formal sleep disorder, defined as a condition that affects sleep quality, timing, or duration, is common both in patients with end-stage knee osteoarthritis (OA) and patients recovering after TKA [13][14][15][16][17] . Poor sleep has farreaching associations with mental health disorders, including anxiety and depression, pain sensitization, paranoia, hallucinations, and relationship distress [18][19][20][21][22] .…”