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PAIN AND SLEEP DURATION IN PEOPLE WITH AMYOTROPHIC LATERAL SCLEROSIS: A PILOT STUDY

Abstract

The bi-directional relationship between pain and sleep, and their time-of-day effects, have been well-established by prior literature focusing on the general population; however, these interactions have yet to be explored in individuals with amyotrophic lateral sclerosis (ALS). PURPOSE: This pilot study aimed to determine whether pain differed in people with ALS (pALS) across time of day, and whether sleep duration was predictive of pain. METHODS: Five pALS (62.2 ± 12.0 years, 33.2 ± 24.1 months since diagnosis, n=4 male) completed the study in their homes. Subjects completed a daily sleep diary and wore a wrist actigraph (ActiGraph GT9X Link) for 6 consecutive days. These outputs were combined to calculate daily sleep duration across a 24-h period, as published elsewhere (Bren et al., 2024). Pain was quantified via self-reported pain intensity and pain interference with activity on a 10 cm Visual Analog Scale (VAS), completed four times per day (near 8:00, 12:00, 18:30, and 20:30). Descriptive statistics, repeated measures ANOVA, and linear regression analyses were conducted with SPSS v29. RESULTS: Overall, the mean (SD) pain intensity was 0.86 (0.26) and pain interference was 0.77 (0.20). In the analysis of time-of-day effects, subjective ratings did not change significantly for pain intensity (p=0.47), or pain interference (p=0.32). In a linear regression model, sleep duration predicted pain intensity (R2=0.20, B=-0.45, p=0.02) and pain interference (R2=0.24, B=-0.49, p<0.01). CONCLUSION: Subjective reports of pain were low. Given that ALS is a motor neuron disease with pain occurring secondary to muscle wasting as the disease progresses, this is not a surprising finding and may reflect the relatively short time since diagnosis of pALS in our sample and/or the use of analgesic medications. Due to the low levels of pain reported by our sample, we did not identify time-of-day effects. Findings also suggest an inverse relationship between sleep duration and pain: as sleep duration increased, pain intensity and interference decreased, highlighting the importance of evaluating sleep duration to improve pain-associated outcomes for pALS. Our findings support the benefit of additional study in a larger sample of pALS with greater variability in clinical characteristics, including time since diagnosis.

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