Fatigue and Sleep-related Impairment as Predictors of the Effect of Nonpharmacological Therapies for Active duty Service Members With Chronic Pain: A Secondary Analysis of a Pragmatic Randomized Clinical Trial.

Autor:	Wi D; Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA., Steffen AD; Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA., Flynn DM; Physical Performance Service Line, Madigan Army Medical Center, Interdisciplinary Pain Management Center, Tacoma, WA 98431, USA., Ransom JC; Physical Performance Service Line, Madigan Army Medical Center, Interdisciplinary Pain Management Center, Tacoma, WA 98431, USA., Orr KP; Office of Reserach Management, Geneva Foundation, Tacoma, WA 98402, USA., McQuinn HM; Physical Performance Service Line, Madigan Army Medical Center, Interdisciplinary Pain Management Center, Tacoma, WA 98431, USA., Snow TJ; Physical Performance Service Line, Madigan Army Medical Center, Interdisciplinary Pain Management Center, Tacoma, WA 98431, USA., Burke LA; Office of Research Facilitation, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA., Park C; Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA., Doorenbos AZ; Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA.; Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA.
Jazyk:	angličtina
Zdroj:	Military medicine [Mil Med] 2024 Nov 08. Date of Electronic Publication: 2024 Nov 08.
DOI:	10.1093/milmed/usae513
Abstrakt:	Introduction: First-line treatments for chronic pain include selected complementary and integrative health therapies, including spinal manipulation, acupuncture, yoga, and massage; and standard rehabilitative care, including physical and occupational therapies. This study aimed to uncover critical factors that contribute to pain impact and the effectiveness of complementary and integrative health therapies and standard rehabilitative care among people with chronic pain, with a focus on the role of sleep-related impairment. Materials and Methods: We conducted a secondary analysis of data from a pragmatic randomized clinical trial of 280 U.S. active duty service members with chronic pain. Results: Our study's multiple mediation analysis examined the indirect effect of complementary and integrative health therapies on pain impact through fatigue (β = - 0.43; 95% CI, -0.99 to -0.07). When stratified by sleep-related impairment, participants with T scores above the median of 62 demonstrated a significant negative indirect effect of complementary and integrative health therapies through fatigue (β = - 0.80; 95% CI, -2.31 to -0.14). This negative indirect effect was not significant for participants with sleep-related impairment T scores below the median (β = - 0.64; 95% CI, -1.48 to 0.07). Conclusion: These findings suggest that complementary and integrative health therapies are particularly effective in reducing pain impact for individuals with higher levels of sleep-related impairment, and that the effect of complementary and integrative health therapies is supported primarily by reducing fatigue. (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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