445: Sleep-Pain Relationship Acute After Motor Vehicle Crash Injury: Roles of Early Psychological Factors

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute posttraumatic pain, Psychology, Gender/sex differences

Background and Aims: The bidirectional relationships between chronic musculoskeletal pain and poor sleep are widely acknowledged, with anxiety, depression, and stress-related processes, including hyperarousal, identified as psychological mechanisms underlying their interplay [1, 2]. However, little is known about how these relationships and underlying psychological pathways operate in the acute stage after minor-to-moderate motor vehicle crash (MVC) injuries. Understanding this will help to identify early intervention targets and optimal prevention strategies for chronic outcomes. The aims of this study were to investigate the sleep-pain relationship in the acute postinjury stage and the potential mediating roles of early anxiety, depression and hyperarousal.

Methods: We used data from Advancing Understanding of RecOvery afteR trauma study (USA adults; minor-to-moderate MVC injury; Injury Severity Scale score ≤15) [3]. Participants were recruited from emergency departments (≤72h of injury). Sleep discontinuity (problems in falling asleep, staying asleep, and early‑morning awakening; 0-4 Likert scales) and 24‑hour average pain (0-10 scale) were assessed at T1(0-3 days) and T3(21-25 days). Hyperarousal, anxiety, and depression were assessed at T2(14-19 days) using versions of modified validated psychological surveys. We tested directional mediation models for sleep-pain relationships with psychological variables as candidate mediators and age, sex, preinjury pain and general mental health as covariates.

Results: We included 2810 participants (n=2810, age=35.6 years; 63.2% females) and found reciprocal relationships between sleep discontinuity and pain between T1-T3 (standardized β [95% confidence intervals]: sleep-to-pain 0.27[0.23, 0.32]; pain-to-sleep 0.27[0.23, 0.32]). The relationship between T1 sleep discontinuity and T3 pain was mediated by T2 psychological factors (indirect effects: hyperarousal 0.09 [0.07, 0.11], anxiety 0.07 [0.05, 0.09], and depression 0.06 [0.04, 0.08]). The relationship between T1 pain and T3 sleep discontinuity was also mediated by these factors (indirect effects: hyperarousal 0.09 [0.07, 0.11], anxiety 0.08 [0.06, 0.10], depression 0.07 [0.05, 0.09]).

Conclusions: This study showed that sleep discontinuity and pain influenced each other during the acute postinjury stage. This highlights a critical window when a reinforcing cycle between poor sleep and pain begins to develop. Hyperarousal, anxiety and depression each partially explained the reciprocal relationships. However, the overall mediating effects of psychological factors were small, indicating that other unexplored mechanisms likely contribute to the sleep-pain relationships in the acute postinjury stage.

References: 1. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-52.
2. Whibley D, et al. Sleep and Pain: A Systematic Review of Studies of Mediation. Clin J Pain. 2019;35(6):544-58.
3. McLean SA, et al. The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure. Mol Psychiatry. 2020;25(2):283-96.

Presenting Author: Wanyun Huang
Submitting Author: Wanyun Huang

Senior Author: Michele Sterling

IASP 2026 Global Year theme of Neuropathic Pain: No

• Wanyun Huang: MSc, BPhty - RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Queensland, Australia; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, Australia; Centre for Innovation in Pain and Health Research (CIPHeR), The University of Queensland, Queensland, Australia
• Nigel Armfield: PhD - RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Queensland, Australia; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, Australia; Centre for Innovation in Pain and Health Research (CIPHeR), The University of Queensland, Queensland, Australia; Centre for Health Services Research, The University of Queensland, Queensland, Australia
• Yanfei Xie: PhD - RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Queensland, Australia; School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, New South Wales, Australia; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, Australia; Centre for Innovation in Pain and Health Research (CIPHeR), The University of Queensland, Queensland, Australia
• Samuel McLean: MD, MPH - Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine, North Carolina, United States; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, North Carolina, United States
• Michele Sterling: PhD, MPhty, BPhty, FACP - RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Queensland, Australia; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, Australia; Centre for Innovation in Pain and Health Research (CIPHeR), The University of Queensland, Queensland, Australia