Commentary: The Importance of Sleep in Pediatric Chronic Pain--A Wake-up Call for Pediatric Psychologists

Historically, sleep problems were not commonly considered as a core component of pediatric chronic pain, in contrast to other well-established correlates, such as physical disability, depression, anxiety, and family disruption. At best, when they were considered, sleep disturbances were viewed as a secondary problem with questionable impact on pediatric pain management. It has been only recently that reviews and empirical studies have drawn our attention to the importance of sleep as a variable that can have a significant influence on, and be influenced by, pediatric chronic pain (e.g., Gagliese & Chambers, 2007; Huntley, Campo, Dahl, & Lewin, 2007; Lewin & Dahl, 1999; Meltzer, Logan, & Mindell, 2005; Miller, Palermo, Powers, Scher, & Hershey, 2003; Palermo & Kiska, 2005). The four studies on sleep and pain published in this special issue (Long et al., this issue; Tsai et al., this issue; Valrie et al., this issue; Ward et al., this issue) together serve to reinforce and extend our current understanding of the importance of sleep in pediatric chronic pain. The studies apply diverse methodologies for assessing sleep (i.e., self-report questionnaires, daily diaries, actigraphy, and polysomnography) across several different chronic pain conditions (i.e., arthritis, musculoskeletal pain, sickle cell disease, and headache), yet the results send a consistent message. Sleep problems are common in children with chronic pain and are related to mood disturbances and difficulties with daily functioning. The application of advanced statistical techniques such as multilevel modeling (Valrie et al., this issue) further highlights the complex interrelationships among sleep, pain, and other variables such as mood.