Individual Differences in Concurrent Developmental Trajectories of Pain and Insomnia in Adolescents Are Predicted by Chronotype and Arousal-causing Pre-sleep Behaviors.

The onset of both chronic pain and insomnia is high during adolescence. Although a bidirectional relationship between pain and insomnia has support, how pain and sleep co-develop throughout adolescence remains unknown. Both sleep-wake patterns and pre-sleep behaviors that cause arousal may influence the co-development of pain and insomnia. Four waves of longitudinal self-report data were used (N baseline = 2767, Age baseline M = 13.65 years, SD = 0.65). Multidimensional growth mixture modeling was used to identify four subgroups of adolescents with different concurrent trajectories of pain and insomnia. The trajectories followed each other across time in all classes: one class of consistently low pain and insomnia (68.7 %), one class with persistent high symptoms (4.9 %), as well as one class of increasing (13.9 %), and one of decreasing (12.5 %), trajectories. Later sleep-wake patterns and more pre-sleep behaviors causing cognitive-emotional arousal predicted both increasing and decreasing trajectories of concurrent pain and insomnia. The current study showed that developmental trajectories of pain and insomnia follow each other within adolescents and across adolescence. Both sleep-phase focused interventions as well as psychological interventions that focus on pre-sleep behaviors causing cognitive-emotional arousal may prove beneficial for adolescents with comorbid pain and insomnia.