Circadian Influence on Pain Incidence During Early Adolescence

Major developmental changes in sleep and circadian systems occur during adolescence. Yet, the circadian influence on pain during these formative years is largely unknown. We investigated the impact of chronotype on pain incidence in U.S. adolescents. Using two years of data from the Adolescent Brain Cognitive Development study, we tested the hypotheses that later chronotypes would be associated with higher risk of developing new onset pain, moderate to severe pain, and multi-region pain 1 year later. Using the Munich ChronoType Questionnaire, chronotype was calculated as the midpoint between sleep onset and offset on free days, corrected for sleep debt over the week. Adolescents reported pain presence over the past month, and if present, rated pain intensity (0-10 NRS; ≥ 4 defined as moderate to severe pain), activity limitations (0-10 NRS), and body site locations (CHOIR Body Map; ≥ 2 regions defined as multi-region pain). Three-level random intercept logistic regression models were specified for each pain outcome, adjusting for sociodemographic and developmental characteristics, sleep duration, and insomnia. Among 5,991 initially pain-free adolescents (mean 12.0 years, SD 0.7), the mean chronotype was 3:59 AM (SD 97 minutes), and 1-year incidence of pain, moderate to severe pain, and multi-region pain was 24.4%, 15.2%, and 13.5%. Each hour later chronotype was associated with a 9% increased odds of developing moderate to severe pain (OR = 1.09, 95% CI 1.03-1.16); associations with incident pain and incident multi-region were not significant. In this diverse U.S. adolescent sample, later chronotypes predicted higher incidence of new onset moderate to severe pain