The Concurrent and Temporal Associations Between Pain Self-Efficacy, Sleep Disturbance, and Pain Intensity in Individuals with Chronic Pain: A Cross-Lagged Analysis.

Purpose: The objective of this study was to replicate and extend prior evidence regarding the concurrent associations among pain self-efficacy, sleep disturbance, and pain intensity in adults with chronic pain, and to evaluate their temporal associations over time. Patients and Methods: This prospective study enrolled 300 Thai chronic pain outpatients from Siriraj Hospital, of whom 50 were excluded due to loss to follow-up, yielding a final sample of 250 participants. Standard questionnaires were administered to assess pain severity, pain self-efficacy, and sleep disturbance at baseline (initial visit) and again at a follow-up assessment conducted about 6 weeks later (range 4-8 weeks). Longitudinal associations were examined using cross-lagged panel models with covariate adjustment, and moderation analyses were conducted using multiple linear regression with interaction terms. Results: Participants were primarily female with a mean age of 54 years; neuropathic pain was the most common condition. Due to the COVID-19, about half of the participants (52%) did not return to the hospital for follow-up. However, they did return completed follow-up questionnaires via email. The average time between two assessments was 6.25 ± 1.77 weeks. Concurrent associations among pain intensity, sleep disturbance, and pain-related self-efficacy were observed in expected directions (correlations ranging from Conclusion: Medium to large concurrent associations were observed in expected directions between measures of pain severity, pain self-efficacy, and sleep disturbance; each of these measures were also stable over time. Only one significant cross-lagged effect emerged, which may reflect statistical suppression rather than a true adverse temporal effect. The temporal associations between these domains require further longitudinal evaluation.