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Peer-reviewedCC BY-NC-ND 4.0Pain

Early codevelopment of pain, sleep disturbance, and hyperarousal after traumatic injury

  • Michele Sterling1,2,3
  • Jenna Liimatainen1,2,3
  • Nigel Armfield1,2
  • Shu-Kay Ng4
  • Samuel McLean5,6
  • Wanyun Huang1,2,3
  • Richard Tawiah4,7
7 affiliations
  1. 1RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
  2. 2NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Australia
  3. 3Centre for Innovation in Pain and Health Research (CIPHeR), The University of Queensland, Brisbane, Australia
  4. 4School of Medicine and Dentistry, Griffith University, Brisbane, Australia
  5. 5Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
  6. 6Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
  7. 7School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Abstract

Chronic pain after traumatic injury likely reflects interacting processes rather than isolated recovery pathways, yet longitudinal evidence examining the joint development of pain, sleep disturbance, and hyperarousal from the acute postinjury stage is limited. We analysed data from the AURORA cohort of emergency department trauma survivors recruited within 72 hours of injury (n = 2834) to characterise trajectories of pain, sleep discontinuity, and hyperarousal over 12 months, identify shared multitrajectory profiles, and examine factors associated with adverse outcomes. Smartphone-based surveys assessed symptoms repeatedly from 1 to 5 days postinjury to one year. Group-based trajectory modelling identified 5 pain (n = 1635), 6 sleep discontinuity (n = 1635), and 5 hyperarousal (n = 1820) trajectories, ranging from rapid recovery to persistent high symptoms. Persistent high pain occurred in 35.1% of participants, while 23.5% followed persistently high or worsening sleep trajectories and 27.2% followed high hyperarousal trajectories. Multitrajectory modelling (n = 1800) identified 6 joint profiles, with 10.6% experiencing persistently high symptoms across all domains and 25.7% showing medium symptom levels. Older age and higher pretrauma pain were associated with adverse trajectories, whereas resilience and better prior mental health were protective. Baseline sleep discontinuity showed the strongest association with persistent high pain (adjusted odds ratio 3.31; 95% confidence interval 2.61-4.18), while physical activity was associated with a lower likelihood of medium-to-high pain trajectories. Female sex and lower income were associated with the most adverse multidomain profile. These findings highlight early postinjury sleep disruption, hyperarousal, and pain as interconnected processes. Targeting multiple domains may offer a promising strategy to prevent chronic pain after injury.

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Cite

BibTeXRIS
BibTeX
@article{sterling2026early,
  title = {{Early codevelopment of pain, sleep disturbance, and hyperarousal after traumatic injury}},
  author = {Michele Sterling and Jenna Liimatainen and Nigel Armfield and Shu-Kay Ng and Samuel McLean and Wanyun Huang and Richard Tawiah},
  journal = {Pain},
  year = {2026},
  month = sep,
  doi = {10.1097/j.pain.0000000000004105},
  url = {https://doi.org/10.1097/j.pain.0000000000004105},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Early codevelopment of pain, sleep disturbance, and hyperarousal after traumatic injury
AU  - Michele Sterling
AU  - Jenna Liimatainen
AU  - Nigel Armfield
AU  - Shu-Kay Ng
AU  - Samuel McLean
AU  - Wanyun Huang
AU  - Richard Tawiah
PY  - 2026
DA  - 2026/09/17
JO  - Pain
DO  - 10.1097/j.pain.0000000000004105
UR  - https://doi.org/10.1097/j.pain.0000000000004105
AB  - Chronic pain after traumatic injury likely reflects interacting processes rather than isolated recovery pathways, yet longitudinal evidence examining the joint development of pain, sleep disturbance, and hyperarousal from the acute postinjury stage is limited. We analysed data from the AURORA cohort of emergency department trauma survivors recruited within 72 hours of injury (n = 2834) to characterise trajectories of pain, sleep discontinuity, and hyperarousal over 12 months, identify shared multitrajectory profiles, and examine factors associated with adverse outcomes. Smartphone-based surveys assessed symptoms repeatedly from 1 to 5 days postinjury to one year. Group-based trajectory modelling identified 5 pain (n = 1635), 6 sleep discontinuity (n = 1635), and 5 hyperarousal (n = 1820) trajectories, ranging from rapid recovery to persistent high symptoms. Persistent high pain occurred in 35.1% of participants, while 23.5% followed persistently high or worsening sleep trajectories and 27.2% followed high hyperarousal trajectories. Multitrajectory modelling (n = 1800) identified 6 joint profiles, with 10.6% experiencing persistently high symptoms across all domains and 25.7% showing medium symptom levels. Older age and higher pretrauma pain were associated with adverse trajectories, whereas resilience and better prior mental health were protective. Baseline sleep discontinuity showed the strongest association with persistent high pain (adjusted odds ratio 3.31; 95% confidence interval 2.61-4.18), while physical activity was associated with a lower likelihood of medium-to-high pain trajectories. Female sex and lower income were associated with the most adverse multidomain profile. These findings highlight early postinjury sleep disruption, hyperarousal, and pain as interconnected processes. Targeting multiple domains may offer a promising strategy to prevent chronic pain after injury.
SN  - 0304-3959
SN  - 1872-6623
ER  -