Predicting Pain Perception Based on Psychological Distress in Patients with Rheumatoid Arthritis: The Mediating Role of Sleep Quality
-
Hosein Etemadi Mehr
,
Hanieh Mohammadizadeh
,
Fatemeh Rohi
,
Sajjad Motamed Monfared
,
Fatemeh Rajabi
Abstract
Background and Objective: Patients with rheumatoid arthritis (RA) often suffer from chronic pain due to the nature of the disease, and in addition to the disease itself, this pain can be aggravated under the influence of psychological fac-tors. The study aimed to predict pain perception based on psychological distress and the mediating role of sleep quality in people with RA.
Materials and Methods: This research was conducted by path analysis, including 202 patients with RA who were se-lected using the convenience sampling method. The study instruments included McGill Pain Questionnaire (MPQ), Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety, and Stress Scale (DASS-21). Descriptive statistics reported frequency, mean, standard deviation (SD), and Pearson correlation. In analytical statistics, path analysis was used. Data were analyzed using SPSS and AMOS software.
Results: Psychological distress (anxiety, stress, and depression) had a direct, statistically significant effect on sleep quality. Sleep quality had a direct effect on pain perception. On the other hand, anxiety, stress, and depression, with the mediating role on sleep quality, had a significant influence on pain perception by 0.11, 0.12, and 0.09, respectively. Descriptive statistics showed that a significant correlation existed among independent, mediation, and criteria variables. The proposed predictive model had a good fit.
Conclusion: Along with medical treatments, we need to pay attention to the role of psychological factors such as psychological distress, depression, and sleep quality in patients with RA.
1. Weisman MH. Rheumatoid arthritis. Oxford, UK: Oxford University Press; 2011.
2. Sanchez-Florez JC, Seija-Butnaru D, Valero EG, et al. Pain Management strategies in rheumatoid arthri-tis: A narrative review. J Pain Palliat Care Pharma-cother 2021; 35: 291-9.
3. Keefe FJ, Somers TJ. Psychological approaches to understanding and treating arthritis pain. Nat Rev Rheumatol 2010; 6: 210-6.
4. Dickens C, McGowan L, Clark-Carter D, et al. Depression in rheumatoid arthritis: A systematic review of the literature with meta-analysis. Psychosom Med 2002; 64: 52-60.
5. Magni G, Moreschi C, Rigatti-Luchini S, et al. Pro-spective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain 1994; 56: 289-97.
6. Marrie RA, Hitchon CA, Walld R, et al. Increased burden of psychiatric disorders in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2018; 70: 970-8.
7. Bacconnier L, Rincheval N, Flipo RM, et al. Psychological distress over time in early rheumatoid arthritis: Results from a longitudinal study in an early arthritis cohort. Rheumatology (Oxford) 2015; 54: 520-7.
8. Matcham F, Rayner L, Steer S, et al. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2013; 52: 2136-48.
9. Isik A, Koca SS, Ozturk A, et al. Anxiety and depression in patients with rheumatoid arthritis. Clin Rheumatol 2007; 26: 872-8.
10. Lindqvist J, Alfredsson L, Klareskog L, et al. Unmet needs in rheumatoid arthritis: A subgroup of patients with high levels of pain, fatigue, and psychosocial distress 3 years after diagnosis. ACR Open Rheumatol 2022; 4: 492-502.
11. Moldofsky H. Rheumatic manifestations of sleep disorders. Curr Opin Rheumatol 2010; 22: 59-63.
12. Taylor-Gjevre RM, Gjevre JA, Nair B, et al. Components of sleep quality and sleep fragmentation in rheumatoid arthritis and osteoarthritis. Musculoskeletal Care 2011; 9: 152-9.
13. Liu T, Geng Y, Han Z, et al. Self-reported sleep disturbance is significantly associated with depression, anxiety, self-efficacy, and stigma in Chinese patients with rheumatoid arthritis. Psychol Health Med 2023; 28: 908-16.
14. Irwin MR, Olmstead R, Carrillo C, et al. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep 2012; 35: 537-43.
15. Axen I. Pain-related sleep disturbance: A prospective study with repeated measures. Clin J Pain 2016; 32: 254-9.
16. Andersen ML, Araujo P, Frange C, et al. Sleep disturbance and pain: A tale of two common problems. Chest 2018; 154: 1249-59.
17. Wang B, Lu Q, Sun F, et al. The relationship between sleep quality and psychological distress and job burnout among Chinese psychiatric nurses. Ind Health 2021; 59: 427-35.
18. Kline RB. Principles and practice of structural equation modeling. New York, NY: Guilford Publications; 2023.
19. Buysse DJ, Reynolds CF3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
20. Farrahi MJ, Nakhaee N, Sheibani V, et al. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16: 79-82.
21. Melzack R. The McGill pain questionnaire: from description to measurement. Anesthesiology 2005; 103: 199-202.
22. Wilkie DJ, Savedra MC, Holzemer WL, et al. Use of the McGill Pain Questionnaire to measure pain: a meta-analysis. Nurs Res 1990; 39: 36-41.
23. Lovibond SH, Lovibond PF. Depression Anxiety Stress Scales (DASS--21). Sydney, Australia: School of Psychology, University of New South Wales; 1995.
24. Kakemam E, Navvabi E, Albelbeisi AH, et al. Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 Items (DASS-21) in a sample of health professionals: A cross-sectional study. BMC Health Serv Res 2022; 22: 111.
25. Schrimpf M, Liegl G, Boeckle M, et al. The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis. Sleep Med 2015; 16: 1313-20.
26. Chang JR, Fu SN, Li X, et al. The differential effects of sleep deprivation on pain perception in individuals with or without chronic pain: A systematic review and meta-analysis. Sleep Med Rev 2022; 66: 101695.
27. Sivertsen B, Lallukka T, Petrie KJ, et al. Sleep and pain sensitivity in adults. Pain 2015; 156: 1433-9.
28. Borders A, Rothman DJ, McAndrew LM. Sleep problems may mediate associations between rumination and PTSD and depressive symptoms among OIF/OEF veterans. Psychol Trauma 2015; 7: 76-84.
29. Volkow ND, Tomasi D, Wang GJ, et al. Evidence that sleep deprivation downregulates dopamine D2R in ventral striatum in the human brain. J Neurosci 2012; 32: 6711-7.
30. Jamieson D, Beaudequin DA, McLoughlin LT, et al. Associations between sleep quality and psychological distress in early adolescence. J Child Adolesc Ment Health 2020; 32: 77-86.
31. Mohammadi S, Maleki M, Tashkeh M, et al. The effectiveness of mindfulness-based cognitive therapy on sleep quality of students with social anxiety disorder. J Sleep Sci 2020; 5: 1-7.
32. Lee YC, Chibnik LB, Lu B, et al. The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2009; 11: R160.
33. Chavare SD. Effect of pain acceptance and coping on the health related quality of life and functional sta-tus in women with rheumatoid arthritis [Thesis]. Pune, India: Savitribai Phule Pune University; 2021.
34. Mohammadpour M, Bavafa A, Foroughi A, et al. Generalized anxiety disorder and comorbid symptoms of sleep: The unified protocol for transdiagnostic treatment of emotional disorders. J Sleep Sci 2019; 3: 80-9.
35. Ursin R. Serotonin and sleep. Sleep Med Rev 2002; 6: 55-69.
2. Sanchez-Florez JC, Seija-Butnaru D, Valero EG, et al. Pain Management strategies in rheumatoid arthri-tis: A narrative review. J Pain Palliat Care Pharma-cother 2021; 35: 291-9.
3. Keefe FJ, Somers TJ. Psychological approaches to understanding and treating arthritis pain. Nat Rev Rheumatol 2010; 6: 210-6.
4. Dickens C, McGowan L, Clark-Carter D, et al. Depression in rheumatoid arthritis: A systematic review of the literature with meta-analysis. Psychosom Med 2002; 64: 52-60.
5. Magni G, Moreschi C, Rigatti-Luchini S, et al. Pro-spective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain 1994; 56: 289-97.
6. Marrie RA, Hitchon CA, Walld R, et al. Increased burden of psychiatric disorders in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2018; 70: 970-8.
7. Bacconnier L, Rincheval N, Flipo RM, et al. Psychological distress over time in early rheumatoid arthritis: Results from a longitudinal study in an early arthritis cohort. Rheumatology (Oxford) 2015; 54: 520-7.
8. Matcham F, Rayner L, Steer S, et al. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2013; 52: 2136-48.
9. Isik A, Koca SS, Ozturk A, et al. Anxiety and depression in patients with rheumatoid arthritis. Clin Rheumatol 2007; 26: 872-8.
10. Lindqvist J, Alfredsson L, Klareskog L, et al. Unmet needs in rheumatoid arthritis: A subgroup of patients with high levels of pain, fatigue, and psychosocial distress 3 years after diagnosis. ACR Open Rheumatol 2022; 4: 492-502.
11. Moldofsky H. Rheumatic manifestations of sleep disorders. Curr Opin Rheumatol 2010; 22: 59-63.
12. Taylor-Gjevre RM, Gjevre JA, Nair B, et al. Components of sleep quality and sleep fragmentation in rheumatoid arthritis and osteoarthritis. Musculoskeletal Care 2011; 9: 152-9.
13. Liu T, Geng Y, Han Z, et al. Self-reported sleep disturbance is significantly associated with depression, anxiety, self-efficacy, and stigma in Chinese patients with rheumatoid arthritis. Psychol Health Med 2023; 28: 908-16.
14. Irwin MR, Olmstead R, Carrillo C, et al. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep 2012; 35: 537-43.
15. Axen I. Pain-related sleep disturbance: A prospective study with repeated measures. Clin J Pain 2016; 32: 254-9.
16. Andersen ML, Araujo P, Frange C, et al. Sleep disturbance and pain: A tale of two common problems. Chest 2018; 154: 1249-59.
17. Wang B, Lu Q, Sun F, et al. The relationship between sleep quality and psychological distress and job burnout among Chinese psychiatric nurses. Ind Health 2021; 59: 427-35.
18. Kline RB. Principles and practice of structural equation modeling. New York, NY: Guilford Publications; 2023.
19. Buysse DJ, Reynolds CF3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
20. Farrahi MJ, Nakhaee N, Sheibani V, et al. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16: 79-82.
21. Melzack R. The McGill pain questionnaire: from description to measurement. Anesthesiology 2005; 103: 199-202.
22. Wilkie DJ, Savedra MC, Holzemer WL, et al. Use of the McGill Pain Questionnaire to measure pain: a meta-analysis. Nurs Res 1990; 39: 36-41.
23. Lovibond SH, Lovibond PF. Depression Anxiety Stress Scales (DASS--21). Sydney, Australia: School of Psychology, University of New South Wales; 1995.
24. Kakemam E, Navvabi E, Albelbeisi AH, et al. Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 Items (DASS-21) in a sample of health professionals: A cross-sectional study. BMC Health Serv Res 2022; 22: 111.
25. Schrimpf M, Liegl G, Boeckle M, et al. The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis. Sleep Med 2015; 16: 1313-20.
26. Chang JR, Fu SN, Li X, et al. The differential effects of sleep deprivation on pain perception in individuals with or without chronic pain: A systematic review and meta-analysis. Sleep Med Rev 2022; 66: 101695.
27. Sivertsen B, Lallukka T, Petrie KJ, et al. Sleep and pain sensitivity in adults. Pain 2015; 156: 1433-9.
28. Borders A, Rothman DJ, McAndrew LM. Sleep problems may mediate associations between rumination and PTSD and depressive symptoms among OIF/OEF veterans. Psychol Trauma 2015; 7: 76-84.
29. Volkow ND, Tomasi D, Wang GJ, et al. Evidence that sleep deprivation downregulates dopamine D2R in ventral striatum in the human brain. J Neurosci 2012; 32: 6711-7.
30. Jamieson D, Beaudequin DA, McLoughlin LT, et al. Associations between sleep quality and psychological distress in early adolescence. J Child Adolesc Ment Health 2020; 32: 77-86.
31. Mohammadi S, Maleki M, Tashkeh M, et al. The effectiveness of mindfulness-based cognitive therapy on sleep quality of students with social anxiety disorder. J Sleep Sci 2020; 5: 1-7.
32. Lee YC, Chibnik LB, Lu B, et al. The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2009; 11: R160.
33. Chavare SD. Effect of pain acceptance and coping on the health related quality of life and functional sta-tus in women with rheumatoid arthritis [Thesis]. Pune, India: Savitribai Phule Pune University; 2021.
34. Mohammadpour M, Bavafa A, Foroughi A, et al. Generalized anxiety disorder and comorbid symptoms of sleep: The unified protocol for transdiagnostic treatment of emotional disorders. J Sleep Sci 2019; 3: 80-9.
35. Ursin R. Serotonin and sleep. Sleep Med Rev 2002; 6: 55-69.
| Files | ||
| Issue | Vol 8 No 1-2 (2023): Winter- Spring | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jss.v8i1-2.17873 | |
| Keywords | ||
| Rheumatoid arthritis; Sleep quality; Pain perception; Psychological stress | ||
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How to Cite
1.
Etemadi Mehr H, Mohammadizadeh H, Rohi F, Motamed Monfared S, Rajabi F. Predicting Pain Perception Based on Psychological Distress in Patients with Rheumatoid Arthritis: The Mediating Role of Sleep Quality. J Sleep Sci. 2025;8(1-2):31-36.
