Skip to main content
SpringerLink
Log in

Depressive Symptoms and Sleep Efficiency Sequentially Mediate Racial Differences in Temporal Summation of Mechanical Pain

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Racial differences in endogenous pain facilitatory processes have been previously reported. Evidence suggests that psychological and behavioral factors, including depressive symptoms and sleep, can alter endogenous pain facilitatory processes. Whether depressive symptoms and sleep might help explain racial differences in endogenous pain facilitatory processes has yet to be determined.

Purpose

This observational, microlongitudinal study examined whether depressive symptoms and sleep were sequential mediators of racial differences in endogenous pain facilitatory processes.

Methods

A total of 50 (26 African American and 24 non-Hispanic white) community-dwelling adults without chronic pain (mean 49.04 years; range 21–77) completed the Center for Epidemiological Studies Depression Scale prior to seven consecutive nights of sleep monitoring with actigraphy in the home environment. Participants subsequently returned to the laboratory for assessment of endogenous pain facilitation using a mechanical temporal summation protocol.

Results

Findings revealed greater depressive symptoms, poorer sleep efficiency, and greater temporal summation of mechanical pain in African Americans compared to non-Hispanic whites. In a sequential mediation model, greater depressive symptoms predicted poorer sleep efficiency (t = −2.55, p = .014), and poorer sleep efficiency predicted enhanced temporal summation of mechanical pain (t = −4.11, p < .001), particularly for African Americans.

Conclusions

This study underscores the importance of examining the contribution of psychological and behavioral factors when addressing racial differences in pain processing. Additionally, it lends support for the deleterious impact of depressive symptoms on sleep efficiency, suggesting that both sequentially mediate racial differences in endogenous pain facilitation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Staud R. The important role of CNS facilitation and inhibition for chronic pain. Int J Clin Rheumatol. 2013; 8(6): 639–646.

    Article  CAS  Google Scholar 

  2. Magerl W, Wilk SH, Treede RD. Secondary hyperalgesia and perceptual wind-up following intradermal injection of capsaicin in humans. Pain. 1998; 74(2–3): 257–268.

    Article  CAS  PubMed  Google Scholar 

  3. Price DD, Hu JW, Dubner R, Gracely RH. Peripheral suppression of first pain and central summation of second pain evoked by noxious heat pulses. Pain. 1977; 3(1): 57–68.

    Article  CAS  PubMed  Google Scholar 

  4. Staud R, Weyl EE, Riley JL, 3rd, Fillingim RB. Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients. PloS one. 2014; 9(2): e89086.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011; 152(3 Suppl): S2–15.

    Article  PubMed  Google Scholar 

  6. Bulls HW, Goodin BR, McNew M, Gossett EW, Bradley LA. Minority aging and endogenous pain facilitatory processes. Pain Med. 2016; 17(6): 1037–48.

    PubMed  Google Scholar 

  7. Goodin BR, Bulls HW, Herbert MS, et al. Temporal summation of pain as a prospective predictor of clinical pain severity in adults aged 45 years and older with knee osteoarthritis: ethnic differences. Psychosom Med. 2014; 76(4): 302–310.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bar KJ, Brehm S, Boettger MK, Boettger S, Wagner G, Sauer H. Pain perception in major depression depends on pain modality. Pain. 2005; 117(1–2): 97–103.

    Article  PubMed  Google Scholar 

  9. de Souza JB, Potvin S, Goffaux P, Charest J, Marchand S. The deficit of pain inhibition in fibromyalgia is more pronounced in patients with comorbid depressive symptoms. Clin J Pain. 2009; 25(2): 123–7.

    Article  PubMed  Google Scholar 

  10. Edwards RR, Grace E, Peterson S, Klick B, Haythornthwaite JA, Smith MT. Sleep continuity and architecture: associations with pain-inhibitory processes in patients with temporomandibular joint disorder. Eur J Pain. 2009; 13(10): 1043–1047.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Lee YC, Lu B, Edwards RR, et al. The role of sleep problems in central pain processing in rheumatoid arthritis. Arthritis Rheum. 2013; 65(1): 59–68.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007; 30(4): 494–505.

    Article  PubMed  Google Scholar 

  13. Dunlop DD, Song J, Lyons JS, Manheim LM, Chang RW. Racial/ethnic differences in rates of depression among preretirement adults. Am J Public Health. 2003; 93(11): 1945–1952.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chen X, Wang R, Zee P, et al. Racial/ethnic differences in sleep disturbances: the multi-ethnic study of atherosclerosis (MESA). Sleep. 2015; 38(6): 877–888.

    PubMed  PubMed Central  Google Scholar 

  15. Ruiter ME, DeCoster J, Jacobs L, Lichstein KL. Sleep disorders in African Americans and Caucasian Americans: a meta-analysis. Behav Sleep Med. 2010; 8(4): 246–259.

    Article  PubMed  Google Scholar 

  16. Ruiter ME, Decoster J, Jacobs L, Lichstein KL. Normal sleep in African-Americans and Caucasian-Americans: a meta-analysis. Sleep Med. 2011; 12(3): 209–214.

    Article  PubMed  Google Scholar 

  17. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013; 14(12): 1539–1552.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lacruz ME, Schmidt-Pokrzywniak A, Dragano N, et al. Depressive symptoms, life satisfaction and prevalence of sleep disturbances in the general population of Germany: results from the Heinz Nixdorf recall study. BMJ open. 2016; 6(1): e007919.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hamilton M. Frequency of symptoms in melancholia (depressive illness). Br J Psychiatry. 1989; 154: 201–206.

    Article  CAS  PubMed  Google Scholar 

  20. Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci. 2008; 10(3): 329–336.

    PubMed  PubMed Central  Google Scholar 

  21. Yates WR, Mitchell J, John Rush A, et al. Clinical features of depression in outpatients with and without co-occurring general medical conditions in STAR*D: confirmatory analysis. Prim Care Companion J Clin Psychiatry. 2007; 9(1): 7–15.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rossler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep. 2008; 31(4): 473–480.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fok M, Stewart R, Besset A, Ritchie K, Prince M. Incidence and persistence of sleep complaints in a community older population. Int J Geriatr Psychiatry. 2010; 25(1): 37–45.

    PubMed  Google Scholar 

  24. Jaussent I, Dauvilliers Y, Ancelin ML, et al. Insomnia symptoms in older adults: associated factors and gender differences. Am J Geriatr Psychiatry. 2011; 19(1): 88–97.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Haack M, Scott-Sutherland J, Santangelo G, Simpson NS, Sethna N, Mullington JM. Pain sensitivity and modulation in primary insomnia. Eur J Pain. 2012; 16(4): 522–533.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Sivertsen B, Lallukka T, Petrie KJ, Steingrimsdottir OA, Stubhaug A, Nielsen CS. Sleep and pain sensitivity in adults. Pain. 2015; 156(8): 1433–1439.

    Article  PubMed  Google Scholar 

  27. Anderson RJ, McCrae CS, Staud R, Berry RB, Robinson ME. Predictors of clinical pain in fibromyalgia: examining the role of sleep. J Pain. 2012; 13(4): 350–358.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Buenaver LF, Quartana PJ, Grace EG, et al. Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: the mediating role of sleep disturbance. Pain. 2012; 153(6): 1159–1166.

    Article  PubMed  Google Scholar 

  29. Petrov ME, Goodin BR, Cruz-Almeida Y, et al. Disrupted sleep is associated with altered pain processing by sex and ethnicity in knee osteoarthritis. J Pain 2015; 16(5): 478–490.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Staud R, Cannon RC, Mauderli AP, Robinson ME, Price DD, Vierck CJ, Jr. Temporal summation of pain from mechanical stimulation of muscle tissue in normal controls and subjects with fibromyalgia syndrome. Pain. 2003; 102(1–2): 87–95.

    Article  PubMed  Google Scholar 

  31. Staud R, Craggs JG, Robinson ME, Perlstein WM, Price DD. Brain activity related to temporal summation of C-fiber evoked pain. Pain. 2007; 129(1–2): 130–142.

    Article  PubMed  Google Scholar 

  32. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1: 385–401.

    Article  Google Scholar 

  33. Turner AD, Capuano AW, Wilson RS, Barnes LL. Depressive symptoms and cognitive decline in older African Americans: two scales and their factors. Am J Geriatr Psychiatry. 2015; 23(6): 568–578.

    Article  PubMed  Google Scholar 

  34. Knight RG, Williams S, McGee R, Olaman S. Psychometric properties of the Centre for Epidemiologic Studies Depression Scale (CES-D) in a sample of women in middle life. Behav Res Therapy. 1997;35(4):373–80.

    Article  CAS  Google Scholar 

  35. Vilagut G, Forero CG, Barbaglia G, Alonso J. Screening for depression in the general population with the Center for Epidemiologic Studies Depression (CES-D): a systematic review with meta-analysis. PloS one. 2016; 11(5): e0155431.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Chung F, Abdullah HR, Liao P. STOP-bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016; 149(3): 631–638.

    Article  PubMed  Google Scholar 

  37. Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108(5):768–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth. 2010; 57(5): 423–438.

    Article  PubMed  Google Scholar 

  39. Gironda RJ, Lloyd J, Clark ME, Walker RL. Preliminary evaluation of reliability and criterion validity of Actiwatch-score. J Rehabil Res Dev. 2007; 44(2): 223–230.

    Article  PubMed  Google Scholar 

  40. Wood AC, Kuntsi J, Asherson P, Saudino KJ. Actigraph data are reliable, with functional reliability increasing with aggregation. Behav Res Methods. 2008; 40(3): 873–878.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Blackwell T, Redline S, Ancoli-Israel S, et al. Comparison of sleep parameters from actigraphy and polysomnography in older women: the SOF study. Sleep. 2008; 31(2): 283–291.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kushida CA, Chang A, Gadkary C, Guilleminault C, Carrillo O, Dement WC. Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients. Sleep Med. 2001; 2(5): 389–396.

    Article  CAS  PubMed  Google Scholar 

  43. O’Donoghue GM, Fox N, Heneghan C, Hurley DA. Objective and subjective assessment of sleep in chronic low back pain patients compared with healthy age and gender matched controls: a pilot study. BMC Musculoskel Disord. 2009; 10: 122.

    Article  Google Scholar 

  44. Sadeh A. The role and validity of actigraphy in sleep medicine: an update. Sleep Med Rev. 2011; 15(4): 259–267.

    Article  PubMed  Google Scholar 

  45. Cruz-Almeida Y, Sibille KT, Goodin BR, et al. Racial and ethnic differences in older adults with knee osteoarthritis. Arthritis Rheum. 2014; 66(7): 1800–1810.

    Article  Google Scholar 

  46. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. 1st Ed. ed. New York, NY: The Guilford Press; 2013.

    Google Scholar 

  47. Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP. The role of actigraphy in the study of sleep and circadian rhythms. Sleep. 2003; 26(3): 342–392.

    Article  PubMed  Google Scholar 

  48. Bulls HW, Freeman EL, Anderson AJ, Robbins MT, Ness TJ, Goodin BR. Sex differences in experimental measures of pain sensitivity and endogenous pain inhibition. J Pain Res. 2015; 8: 311–320.

    PubMed  PubMed Central  Google Scholar 

  49. Riley JL, 3rd, Cruz-Almeida Y, Glover TL, et al. Age and race effects on pain sensitivity and modulation among middle-aged and older adults. J Pain. 2014; 15(3): 272–282.

    Article  PubMed  Google Scholar 

  50. Harris M, Glozier N, Ratnavadivel R, Grunstein RR. Obstructive sleep apnea and depression. Sleep Med Rev. 2009; 13(6): 437–444.

    Article  PubMed  Google Scholar 

  51. Roure N, Gomez S, Mediano O, et al. Daytime sleepiness and polysomnography in obstructive sleep apnea patients. Sleep Med. 2008; 9(7): 727–731.

    Article  PubMed  Google Scholar 

  52. Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Manage. 2012; 2(3): 219–230.

    Article  Google Scholar 

  53. Yarnitsky D, Granot M, Granovsky Y. Pain modulation profile and pain therapy: between pro- and antinociception. Pain. 2014; 155(4): 663–665.

    Article  PubMed  Google Scholar 

  54. Cruz-Almeida Y, Riley JL, 3rd, Fillingim RB. Experimental pain phenotype profiles in a racially and ethnically diverse sample of healthy adults. Pain Med. 2013; 14(11): 1708–1718.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Rahim-Williams B, Riley JL, 3rd, Williams AK, Fillingim RB. A quantitative review of ethnic group differences in experimental pain response: do biology, psychology, and culture matter? Pain Med. 2012; 13(4): 522–540.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Mossey JM. Defining racial and ethnic disparities in pain management. Clin Orthop Relat Res. 2011; 469(7): 1859–1870.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008; 4(5): 487–504.

    PubMed  PubMed Central  Google Scholar 

  58. Plant EA, Sachs-Ericsson N. Racial and ethnic differences in depression: the roles of social support and meeting basic needs. J Consult Clin Psychol. 2004; 72(1): 41–52.

    Article  PubMed  Google Scholar 

  59. Lustberg L, Reynolds CF. Depression and insomnia: questions of cause and effect. Sleep Med Rev. 2000; 4(3): 253–262.

    Article  PubMed  Google Scholar 

  60. Liu X, Buysse DJ, Gentzler AL, et al. Insomnia and hypersomnia associated with depressive phenomenology and comorbidity in childhood depression. Sleep. 2007; 30(1): 83–90.

    Article  PubMed  Google Scholar 

  61. Patel SR, Malhotra A, Gottlieb DJ, White DP, Hu FB. Correlates of long sleep duration. Sleep. 2006; 29(7): 881–889.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Ericsson M, Poston WS, Linder J, Taylor JE, Haddock CK, Foreyt JP. Depression predicts disability in long-term chronic pain patients. Disabil Rehabil. 2002; 24(6): 334–340.

    Article  CAS  PubMed  Google Scholar 

  63. Weissman-Fogel I, Granovsky Y, Crispel Y, et al. Enhanced presurgical pain temporal summation response predicts post-thoracotomy pain intensity during the acute postoperative phase. J Pain. 2009; 10(6): 628–636.

    Article  PubMed  Google Scholar 

  64. Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003; 4(3): 277–294.

    Article  PubMed  Google Scholar 

  65. Gregory AM, Rijsdijk FV, Lau JY, Dahl RE, Eley TC. The direction of longitudinal associations between sleep problems and depression symptoms: a study of twins aged 8 and 10 years. Sleep. 2009; 32(2): 189–199.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Sivertsen B, Salo P, Mykletun A, et al. The bidirectional association between depression and insomnia: the HUNT study. Psychosom Med. 2012; 74(7): 758–65.

    Article  PubMed  Google Scholar 

  67. Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: coincidence or consequence? J Neuroendocrinol. 2001; 13(12): 1009–1023.

    Article  CAS  PubMed  Google Scholar 

  68. Kojima M, Kojima T, Suzuki S, et al. Depression, inflammation, and pain in patients with rheumatoid arthritis. Arthritis Rheum. 2009; 61(8): 1018–1024.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Support for this study was provided by an NIH/NIA Health Disparities Research Pilot Award through the Deep South Resource Center for Minority Aging Research (RCMAR); 5P30AG031054.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    Hailey W. Bulls MA, Mary K. Lynch MA, Ethan W. Gossett BS, Michael A. Owens BS, BA, Sarah C. Terry BS, Kate M. Wesson-Sides BS & Burel R. Goodin PhD

  2. College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA

    Megan E. Petrov PhD

  3. Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 328, Birmingham, AL, 35294, USA

    Burel R. Goodin PhD

Authors
  1. Hailey W. Bulls MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary K. Lynch MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Megan E. Petrov PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ethan W. Gossett BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael A. Owens BS, BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sarah C. Terry BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kate M. Wesson-Sides BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Burel R. Goodin PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Burel R. Goodin PhD.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflicts of interest.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bulls, H.W., Lynch, M.K., Petrov, M.E. et al. Depressive Symptoms and Sleep Efficiency Sequentially Mediate Racial Differences in Temporal Summation of Mechanical Pain. ann. behav. med. 51, 673–682 (2017). https://doi.org/10.1007/s12160-017-9889-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-017-9889-x

Keywords

Search

Navigation