Understanding the Sleep-Pain Relationship in Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is a gastrointestinal disease with a chronic course characterized by remissions and relapse. IBD is associated with sleep difficulties and pain. Sleep disturbance and pain often co-occur, yet theory-driven research examining the nature of the sleep-pain relationship in IBD is limited. Through a 3P model lens, psychosocial variables, including adverse childhood experiences (ACEs), pain catastrophizing, depressive symptoms, and anxiety, are important variables that may act as predisposing, precipitating, or perpetuating factors in the sleep-pain relationship. The strong connections between sleep and pain, along with evidence indicating their importance in disease outcomes, suggest that understanding how sleep and pain are related in IBD is an important area of research. The primary aim of the current study was to examine the sleep-pain relationship in IBD and understand the role of psychosocial factors in the sleep-pain relationship. Participants with IBD (n=487) completed study measures (i.e., ACEs, pain catastrophizing, depressive symptoms, anxiety, sleep disturbance, pain) yearly for four years and healthy controls (n=896) completed baseline measures. Preliminary analyses revealed differences in sleep disturbance and pain by disease state and sex assigned at birth. Parallel process latent growth models indicated longitudinal associations between sleep and pain in IBD, and the nature of the sleep-pain relationship differed for male and female participants. Structural equation modelling examined associations between study variables’ baseline scores and changes across time. Pain catastrophizing was associated with baseline sleep disturbance and pain, whereas ACEs were associated with only sleep disturbance. Baseline sleep disturbance was associated with baseline depressive symptom and anxiety scores, which were associated with pain scores at baseline but not changes in pain. Changes in sleep were associated with changes in pain. The role of depressive symptoms and anxiety in the sleep-pain relationship differed for male and female participants. Although further longitudinal research is needed to parse apart the directionality and role of psychosocial factors in the sleep-pain relationship in IBD, this thesis provided a crucial first step in understanding how and why sleep and pain may be related in a chronic gastrointestinal disease population. Clinical implications and future directions are discussed.