439: Chronic Pain and Processing Speed Link Poor Sleep to Slower Gait Speed in Older Adults

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Neuroimmunology, Treatment/management , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Sleep disturbance and slower gait are each associated with disability in older adults, yet the variables that account for their association are poorly characterized. Poor sleep is linked to greater clinical pain, and greater pain co-occurs with slower gait—suggesting that pain may statistically account for the sleep–gait association. Additionally, chronic pain is associated with reduced processing speed, which independently predicts gait velocity in aging. Using cross-sectional mediation analysis, we tested whether pain accounts for the sleep–gait association and whether cognitive function further explains it in a serial model: Sleep→Pain→Cognition→Gait.

Methods: A cross-sectional study of UPBEAT cohort older adults (n=134; 60–95 years) with chronic musculoskeletal pain. Sleep disturbance was assessed using PSQI, pain with WOMAC and GCPS, cognitive processing speed/executive function with Trail Making A/B, Stroop, and Ruff Figural Fluency, and gait velocity during preferred-pace walking. Mediation analyses tested whether pain accounted for sleep–gait associations (Sleep → Pain → Gait; a×b) and whether cognition further explained this relationship (Sleep → Pain → Cognition → Gait; a×d×b). Because pain scores included many zero values, two-part models were used. Indirect effects were estimated using bias-corrected bootstrap confidence intervals corrected for multiple comparisons.

Results: Pain accounted for sleep–gait associations in 11/24 models after Bonferroni correction (Sleep → Pain → Gait), explaining >95% of indirect variance. Each 1-point higher PSQI score corresponded to 4.3–7.5 cm/s slower gait through pain. When cognition was added (Sleep → Pain → Cognition → Gait), only WOMAC pain × Trail Making A models showed meaningful serial effects, with each PSQI point corresponding to 2.0 cm/s slower gait through the pain–processing speed pathway (12.2% variance explained). Processing speed accounted for 10–31% of the pain–gait association across models, all remaining significant after correction.

Conclusions: Pain emerged as the primary variable accounting for sleep–gait associations, explaining most indirect variance. Processing speed added a modest but consistent serial contribution, accounting for up to one-third of the pain–gait relationship depending on the pain measure. As all variables were measured at a single time point, findings reflect statistical associations consistent with the proposed ordering rather than causal effects. Nevertheless, consistency across sleep and pain measures and the specificity of processing speed as a contributor suggest these pathways represent plausible mechanisms linking sleep disturbance, pain, and mobility that warrant testing in longitudinal studies.

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Presenting Author: Soamy Montesino Goicolea
Submitting Author: Soamy Montesino Goicolea

Senior Author: Yenisel Cruz-Almeida

IASP 2026 Global Year theme of Neuropathic Pain: No

• Soamy Montesino Goicolea: MD - University of Florida
• Pedro A. Valdes Hernandez: PhD - University of Florida
• Ania Lauren Lipat: PhD - University of Central Florida
• Stephen A Coombes: PhD - University of Florida
• Yenisel Cruz-Almeida: PhD - University of Florida