Injustice Appraisals Mediate the Relationship between Pain Intensity and Sleep Impairment in Children with Chronic Pain

Chronic pain and sleep impairment frequently co-occur in children. Appraising one’s pain as unjust (“pain-related injustice”) has been associated with unique variability in cognitive, emotional, and functional outcomes among children with chronic pain. Less is known about the relationship between pain-related injustice and sleep impairment. The purpose of this study was to 1) examine the associations between pain intensity, injustice appraisals, and sleep impairment in children with chronic pain, and 2) examine whether injustice appraisals mediate the relationship between pain intensity and sleep impairment. The sample included children with chronic pain (N=249, Mage=14.3 years, 73.5% female, 89% White) receiving care at an outpatient university-based pain clinic. Children completed measures of pain intensity, pain-related injustice, and sleep impairment. Pain intensity was positively correlated with pain-related injustice (r=.32, p<0.01) and sleep impairment (r=.22, p<0.01), and pain-related injustice was positively correlated with sleep impairment (r=.37, p<0.01). Bootstrapped mediation analysis indicated that injustice appraisals mediated the relationship between pain intensity and sleep impairment (point estimate of indirect effect=.28, 95% CI:.15,.48). These results suggest that injustice appraisals about pain may play a mechanistic role in the association between pain intensity and sleep impairment in children with chronic pain. Longitudinal studies are needed to confirm the causal direction of these relationships. Ultimately, this line or work may inform justice-focused, cognitive-emotional interventions to reduce pain, enhance sleep, and maximize quality of life among children with chronic pain.