Insomnia and chronic pain share the same catastrophizing cognitive tendency. The high prevalence of insomnia and chronic pain was found in the urban population. Seeing the interaction between both in influencing individuals is imperative. Most studies in insomnia and pain are conducted in the Western population, with little to no research conducted in Indonesian urban population. As a part longitudinal chronic pain study, this research explored (a) the mediating role of pain catastrophizing in linking insomnia with health-related quality of life (HRQoL) and (b) the moderating role of anxiety trait in influencing the mediation within Indonesian adults with chronic pain. The data were gathered through self-administered online questionnaires, and the moderated-mediation analyses were conducted at the beginning phase of the longitudinal study. The results from 415 participants validated that pain catastrophizing partially mediated the relationship between insomnia and HRQoL. Furthermore, no significant moderating effect of anxiety trait was found. People with insomnia showed rumination, worry, and dysfunctional beliefs regarding their sleep, which generalized into catastrophic thoughts regarding their pain experience. This pain catastrophizing in turn influenced the HRQoL. Interventions that simultaneously target both catastrophic thoughts in insomnia and pain would prove to be beneficial in mitigating pain among Indonesian adults.


Buenaver, L. F., Quartana, P. J., Grace, E. G., Sarlani, E., Simango, M., Edwards, R. R., Haythornthwaite, J. A., & Smith, M. T. (2012). Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: The mediating role of sleep disturbance. Pain, 153(6), 1159–1166. https://doi.org/10.1016/j.pain.2012.01.023
Burri, A., Ogata, S., Rice, D., & Williams, F. (2018). Pain catastrophizing, neuroticism, fear of pain, and anxiety: Defining the genetic and environmental factors in a sample of female twins. PLOS ONE, 13(3), e0194562. https://doi.org/10.1371/journal.pone.0194562
Dragioti, E., Levin, L. Å., Bernfort, L., Larsson, B., & Gerdle, B. (2017). Insomnia severity and its relationship with demographics, pain features, anxiety, and depression in older adults with and without pain: Cross-sectional population-based results from the PainS65+ cohort. Annals of General Psychiatry, 16(1), 1–10. https://doi.org/10.1186/s12991-017-0137-3
Edwards, R. R., Bingham, C. O., Bathon, J., & Haythornthwaite, J. A. (2006). Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis & Rheumatism, 55(2), 325–332. https://doi.org/10.1002/art.21865
Fabian, L. A., McGuire, L., Goodin, B. R., & Edwards, R. R. (2011). Ethnicity, Catastrophizing, and Qualities of the Pain Experience. Pain Medicine, 12(2), 314–321. https://doi.org/10.1111/j.1526-4637.2010.01015.x
Finan, P. H., & Smith, M. T. (2013). The comorbidity of insomnia, chronic pain, and depression: Dopamine as a putative mechanism. Sleep Medicine Reviews, 17(3), 173–183. https://doi.org/10.1016/j.smrv.2012.03.003
Flink, I. L., Boersma, K., & Linton, S. J. (2013). Pain Catastrophizing as Repetitive Negative Thinking: A Development of the Conceptualization. Cognitive Behaviour Therapy, 42(3), 215–223. https://doi.org/10.1080/16506073.2013.769621
Galvez-Sánchez, C. M., Montoro, C. I., Duschek, S., & Reyes del Paso, G. A. (2020). Depression and trait-anxiety mediate the influence of clinical pain on health-related quality of life in fibromyalgia. Journal of Affective Disorders, 265(October 2018), 486–495. https://doi.org/10.1016/j.jad.2020.01.129
Greenberg, J., Mace, R. A., Funes, C. J., Silverberg, N. D., Iverson, G. L., Caplan, D. N., & Vranceanu, A. M. (2020). Pain Catastrophizing and Limiting Behavior Mediate the Association Between Anxiety and Postconcussion Symptoms. Psychosomatics, 61(1), 49–55. https://doi.org/10.1016/j.psym.2019.09.004
Gutiérrez-García, G. A., & Contreras, M. C. (2013). Anxiety: An Adaptive Emotion. In F. Durbano (Ed.), New Insights into Anxiety Disorders (pp. 21–37). InTech. https://doi.org/10.5772/53223
Hayes, A. F. (2017). Introduction to Mediation, Moderation and Conditional Process Analysis - Appendices A & B (V3). In Methodology in the Social Sciences (Vol. 53, p. 527). https://books.google.de/books?hl=en&lr=&id=6uk7DwAAQBAJ&oi=fnd&pg=PP1&ots=YZT5nUOwnF&sig=MHqqjLCOChgix8LtpSh-0FAX1gg#v=onepage&q&f=false
Hsieh, A. Y., Tripp, D. A., Ji, L.-J., & Sullivan, M. J. L. (2010). Comparisons of Catastrophizing, Pain Attitudes, and Cold-Pressor Pain Experience Between Chinese and European Canadian Young Adults. The Journal of Pain, 11(11), 1187–1194. https://doi.org/10.1016/j.jpain.2010.02.015
Ikemoto, T., Hayashi, K., Shiro, Y., Arai, Y., Marcuzzi, A., Costa, D., & Wrigley, P. (2020). A systematic review of cross‐cultural validation of the pain catastrophizing scale. European Journal of Pain, 24(7), 1228–1241. https://doi.org/10.1002/ejp.1587
Jeff Bryson, W., Read, J. B., Bush, J. P., & Edwards, C. L. (2015). The Need for an Integrated Cognitive-Behavioral Model for Co-occurring Chronic Pain and Insomnia. Journal of Rational - Emotive and Cognitive - Behavior Therapy, 33(3), 239–257. https://doi.org/10.1007/s10942-015-0213-z
Kaplan, K. A., Talbot, L. S., & Harvey, A. G. (2009). Cognitive Mechanisms in Chronic Insomnia: Processes and Prospects. Sleep Medicine Clinics, 4(4), 541–548. https://doi.org/10.1016/j.jsmc.2009.07.007
Kelly, G. A., Blake, C., Power, C. K., OʼKeeffe, D., & Fullen, B. M. (2011). The Association Between Chronic Low Back Pain and Sleep. The Clinical Journal of Pain, 27(2), 169–181. https://doi.org/10.1097/AJP.0b013e3181f3bdd5
Kishi, A., Natelson, B. H., Togo, F., Struzik, Z. R., Rapoport, D. M., & Yamamoto, Y. (2010). Sleep stage transitions in chronic fatigue syndrome patients with or without fibromyalgia. 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology, 5391–5394. https://doi.org/10.1109/IEMBS.2010.5626478
Larice, S., Ghiggia, A., Di Tella, M., Romeo, A., Gasparetto, E., Fusaro, E., Castelli, L., & Tesio, V. (2020). Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis. Scandinavian Journal of Psychology, 61(2), 271–280. https://doi.org/10.1111/sjop.12592
Leal, P. C., Goes, T. C., da Silva, L. C. F., & Teixeira-Silva, F. (2017). Trait vs. state anxiety in different threatening situations. Trends in Psychiatry and Psychotherapy, 39(3), 147–157. https://doi.org/10.1590/2237-6089-2016-0044
Lerman, S. F., Finan, P. H., Smith, M. T., & Haythornthwaite, J. A. (2017). Psychological interventions that target sleep reduce pain catastrophizing in knee osteoarthritis. PAIN, 158(11), 2189–2195. https://doi.org/10.1097/j.pain.0000000000001023
Lin, M. C., Endler, N. S., & Kocovski, N. L. (2001). State and trait anxiety: A cross-cultural comparison of Chinese and Caucasian students in Canada. Current Psychology, 20(1), 95–111. https://doi.org/10.1007/s12144-001-1006-3
MacDonald, S., Linton, S. J., & Jansson-Fröjmark, M. (2008). Avoidant Safety Behaviors and Catastrophizing: Shared cognitive-behavioral processes and consequences in co-morbid pain and sleep disorders. International Journal of Behavioral Medicine, 15(3), 201–210. https://doi.org/10.1080/10705500802222675
Mascarenhas, D. R. D., & Smith, N. C. (2011). Developing the performance brain. In Performance Psychology (pp. 245–267). Elsevier. https://doi.org/10.1016/B978-0-443-06734-1.00017-1
Mathias, J. L., Cant, M. L., & Burke, A. L. J. (2018). Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis. Sleep Medicine, 52, 198–210. https://doi.org/10.1016/j.sleep.2018.05.023
Morin, C. M., Belleville, G., Bélanger, L., & Ivers, H. (2011). The Insomnia Severity Index: Psychometric Indicators to Detect Insomnia Cases and Evaluate Treatment Response. Sleep, 34(5), 601–608. https://doi.org/10.1093/sleep/34.5.601
Neblett, R. (2017). Pain catastrophizing: An historical perspective. Journal of Applied Biobehavioral Research, 22(1), 1–6. https://doi.org/10.1111/jabr.12086
Palermo, T. M., Law, E., Churchill, S. S., & Walker, A. (2012). Longitudinal course and impact of insomnia symptoms in adolescents with and without chronic pain. Journal of Pain, 13(11), 1099–1106. https://doi.org/10.1016/j.jpain.2012.08.003
Roberts, M. B., & Drummond, P. D. (2016). Sleep Problems are Associated With Chronic Pain Over and Above Mutual Associations With Depression and Catastrophizing. The Clinical Journal of Pain, 32(9), 792–799. https://doi.org/http://dx.doi.org/10.1097/AJP.0000000000000329
Santangelo, G., Sacco, R., Siciliano, M., Bisecco, A., Muzzo, G., Docimo, R., De Stefano, M., Bonavita, S., Lavorgna, L., Tedeschi, G., Trojano, L., & Gallo, A. (2016). Anxiety in Multiple Sclerosis: psychometric properties of the State-Trait Anxiety Inventory. Acta Neurologica Scandinavica, 134(6), 458–466. https://doi.org/10.1111/ane.12564
Shim, E. J., Hahm, B. J., Go, D. J., Lee, K. M., Noh, H. L., Park, S. H., & Song, Y. W. (2018). Modeling quality of life in patients with rheumatic diseases: the role of pain catastrophizing, fear-avoidance beliefs, physical disability, and depression. Disability and Rehabilitation, 40(13), 1509–1516. https://doi.org/10.1080/09638288.2017.1300691
Siciliano, M., Trojano, L., Trojsi, F., Monsurrò, M. R., Tedeschi, G., & Santangelo, G. (2019). Assessing anxiety and its correlates in amyotrophic lateral sclerosis: The state‐trait anxiety inventory. Muscle & Nerve, mus.26475. https://doi.org/10.1002/mus.26475
Sørensen, L., Jensen, M. S. A., Rathleff, M. S., & Holden, S. (2019). Comorbid insomnia, psychological symptoms and widespread pain among patients suffering from musculoskeletal pain in general practice: A cross-sectional study. BMJ Open, 9(6), 1–8. https://doi.org/10.1136/bmjopen-2019-031971
Spielberger, C. D. (1983). State-Trait Anxiety Inventory for Adults. https://doi.org/https://doi.org/10.1037/t06496-000
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/10.1037/1040-3590.7.4.524
Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain, 17(1), 52–64. https://doi.org/10.1097/00002508-200103000-00008
Swanenghyun, G. (2015). Validitas dan reliabilitas alat ukur insomnia severity index (ISI-INA) pada remaja jalanan di Yogyakarta. Universitas Gadjah Mada.
Tang, N. K. Y. (2018). Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 87, 281–289. https://doi.org/10.1016/j.pnpbp.2017.02.023
Tang, N. K. Y., Wright, K. J., & Salkovskis, P. M. (2007). Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. Journal of Sleep Research, 16(1), 85–95. https://doi.org/10.1111/j.1365-2869.2007.00571.x
Taylor, S. S., Davis, M. C., Yeung, E. W., Zautra, A. J., & Tennen, H. A. (2017). Relations between adaptive and maladaptive pain cognitions and within-day pain exacerbations in individuals with fibromyalgia. Journal of Behavioral Medicine, 40(3), 458–467. https://doi.org/10.1007/s10865-016-9811-1
Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Kosek, E., Lavandʼhomme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., Smith, B. H., … Wang, S.-J. (2015). A classification of chronic pain for ICD-11. PAIN, 1. https://doi.org/10.1097/j.pain.0000000000000160
Turkyilmaz, A. K., Kurt, E. E., Karkucak, M., & Capkin, E. (2012). Sociodemographic Characteristics, Clinical Signs and Quality of Life in Patients with Fibromyalgia. The Eurasian Journal of Medicine, 44(2), 88–93. https://doi.org/10.5152/eajm.2012.21
van Aken, M. A. W., Oosterman, J. M., van Rijn, C. M., Ferdek, M. A., Ruigt, G. S. F., Peeters, B. W. M. M., Braat, D. D. M., & Nap, A. W. (2017). Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment. Fertility and Sterility, 108(4), 679–686. https://doi.org/10.1016/j.fertnstert.2017.07.016
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332. https://doi.org/10.1016/S0304-3959(99)00242-0
Wagner, J.-S., DiBonaventura, M. D., Chandran, A. B., & Cappelleri, J. C. (2012). The association of sleep difficulties with health-related quality of life among patients with fibromyalgia. BMC Musculoskeletal Disorders, 13(1), 199. https://doi.org/10.1186/1471-2474-13-199
Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity. Medical Care, 34(3), 220–233. https://doi.org/10.1097/00005650-199603000-00003
Wei, Y., Blanken, T. F., & Van Someren, E. J. W. (2018). Insomnia really hurts: Effect of a bad night’s sleep on pain increases with insomnia severity. Frontiers in Psychiatry, 9(AUG), 1–8. https://doi.org/10.3389/fpsyt.2018.00377
Wicaksana, A. L., Maharani, E., & Hertanti, N. S. (2020). The Indonesian version of the Medical Outcome Survey ‐ Short Form 12 version 2 among patients with cardiovascular diseases. International Journal of Nursing Practice, 26(2). https://doi.org/10.1111/ijn.12804



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