The Impact of Pain on Anxiety and Depression is Mediated by Objective and Subjective Sleep Characteristics in Fibromyalgia Patients

Abstract

These findings show a high prevalence of sleep problems in individuals with FM and suggest that they play a role in the relationship between pain and anxiety and depression. In fact, the impact of chronic pain on the later emotional variables was mediated not only by self-efficacy but also by subjective sleep quality and, especially, by objective sleep efficiency.

Fibromyalgia: A Critical and Comprehensive Review

“…In addition, sleep duration, but not sleep quality, predicted the ability to recover from stressful days, and the effects of several nights of inadequate sleep were cumulative [165]. Both sleep disturbances and pain are also linked to depressive and anxiety symptoms and functional limitations [141,161,166], but there is some disagreement over the directionality of these associations. One model shows the path going from disturbed sleep via pain and ineffective coping style to distress and functional limitations [166].…”

“…Indeed, pain, helplessness, a passive coping style, and family cohesion were all directly related to depressive symptoms, but pain was also found to make an indirect contribution to depressive mood via its association with helplessness and passive coping [275]. Sleep disturbances are another important element in these pathways, but it remains somewhat uncertain whether they constitute a mediator of the link between pain and distress or exert their effect by increasing pain [141,161,166]. In another longitudinal study, an increase in pain predicted a rise in emotional distress, and pain and emotional distress each predicted heightened fatigue, with these increases being small, but statistically significant [84].…”

“…One model shows the path going from disturbed sleep via pain and ineffective coping style to distress and functional limitations [166]. The other shows the path to start with pain and go via sleep quality and self-efficacy to distress and daily functioning [141,161].…”

“…Among other predictors of sleep quality, comorbid depression may be an important determinant of sleep difficulties [158], but that is not a consistent finding [139]. Other factors that are associated with self-reported sleep quality include pain, symptom severity, depression, anxiety, perceived disability, levels of perceived stress, and dysfunctional beliefs about sleep, but also physical activity and self-efficacy [141,[159][160][161]. Symptom severity also correlated with an objective measure of sleep fragmentation [144].…”

Sleep disturbances in fibromyalgia syndrome: the role of clinical and polysomnographic variables explaining poor sleep quality in patients

“…As the clinical profiles of these patients are quite variable, FMS would not constitute a single clinical entity, sleep disturbances being a key symptom to differentiate among patients' typologies [41,42]. Furthermore, sleep is a factor that has bidirectional relationships with pain [43], and it magnifies adverse pain-related outcomes in FMS [44,45]. Thus, the existence of sleep disturbances in FMS is a complex problem that remains contested in the literature, even when the recognition and treatment of sleep complaints in FMS is a priority for physicians.…”