Background & Aims

The experience of pain is complex and influenced by various lifestyle and psychophysical factors. Pain shares contextual and biological pathways with stress [1], exerting vital biological effects in their acute phase, with the potential to undergo chronification and maladaptive processes causing detrimental effects on health. Chronic stress negatively impacts mental and physical health, and higher perceived stress levels have been found to increase the risk of pain development in a sample of Danish healthcare workers [2]. Similarly, patients with chronic pain have been shown to have higher basal levels of stress hormones, which might indicate maladaptive stress responses [3]. Finally, perceived stress has been found to predict both physical and mental health in patients with chronic pain [4] and to be associated with increased pain intensity and interference in older adults with chronic pain [5]. Therefore, this study aims to investigate how stress impacts lifestyle and pain.

Methods

This cross-sectional study included a community-based sample of individuals sampled from Aalborg, Denmark, in november 2023. All participants answered four validated questionnaires to investigate lifestyle factors, including the Pittsburgh Sleep Quality Index (PSQI), Rapid Assessment of Physical Activity (RAPA), Fantastic Lifestyle Checklist (FLC), and Perceived Stress Scale (PSS). Further, respondents were asked for detailed information about pain and painful events during the past month. If the respondent reported pain, they were asked about the onset, duration, and location. Then, for each reported pain site, they were asked for intensity, functional impact, triggers, and how the pain affects daily life. Respondents were grouped based on PSS scores as either having ‘low stress’ (PSS 0-13), ‘moderate stress’ (PSS 14-26), or ‘high stress’ (PSS 27-40).

Results

A total of 245 individuals participated in the study of which 154 completed all questionnaires and were included for analysis. There were no significant differences between included and excluded respondents based on age, gender, BMI, or ethnicity. High-stress respondents had poorer FLC scores (F2,151=39.9, p<0.001) and poorer quality of sleep (F2,151=13.3, p<0.001) compared to both low- and moderate-stress respondents. Further, 73% of high-stress respondents reported pain within the past month with higher pain intensities compared to those with pain and low stress (F2, 81 = 4.8, p=0.011) along with higher occurrence of multisite pain compared to those with pain and low and moderate stress (F2, 81=7.4, p=0.001). More high-stress respondents reported that pain affected their mood (?2(1, N = 84) = 9.2, p=0.010), pain is triggered by poor sleep (?2(1, N = 84) = 6.9, p=0.032) and emotional factors (?2(1, N = 84) = 9.6, p=0.008) compared to low-stress respondents.

Conclusions

This study highlights that high perceived stress has significant negative impacts on psychophysical health with poorer lifestyle and quality of sleep. Further, high stress was associated with increased pain intensities and occurrence of multisite pain and seems to attenuate the impacts of pain on mood, while increasing the impacts of poor sleep and emotional factors on pain.

References

[1]Abdallah CG, Geha P. Chronic Pain, and Chronic Stress: Two Sides of the Same Coin? Chronic Stress (Thousand Oaks, Calif) 2017;1. https://doi.org/10.1177/2470547017704763.
[2]Vinstrup J, Jakobsen MD, Andersen LL. Perceived Stress and Low-Back Pain Among Healthcare Workers: A Multi-Center Prospective Cohort Study. Front Public Heal 2020;8:528967. https://doi.org/10.3389/FPUBH.2020.00297/BIBTEX.
[3]Vachon-Presseau E. Effects of stress on the corticolimbic system: implications for chronic pain. Prog Neuro-Psychopharmacology Biol Psychiatry 2018;87:216–23. https://doi.org/10.1016/J.PNPBP.2017.10.014.
[4]Castarlenas E, Galán S, Solé E, Roy R, Sánchez-Rodríguez E, Jensen MP, et al. Perceived Stress, Perceived Social Support, and Global Health in Adults with Chronic Pain. Int J Behav Med 2023:1–10. https://doi.org/10.1007/S12529-023-10250-6/TABLES/5.
[5]White RS, Jiang J, Hall CB, Katz MJ, Zimmerman ME, Sliwinski M, et al. Higher Perceived Stress Scale Scores Are Associated with Higher Pain Intensity and Pain Interference Levels in Older Adults. J Am Geriatr Soc 2014;62:2350–6. https://doi.org/10.1111/JGS.13135.

Presenting Author

Emma Hertel

Poster Authors

Emma Hertel

Msc

Aalborg University

Lead Author

Mikkel Skov

Lead Author

Taylor Samuel Sweka

Lead Author

Emma Rahbek Lavesen

Lead Author

Astrid Marie Schuldt Andersen

Lead Author

Kristian Petersen

PhD

Aalborg University, Aalborg, Denmark

Lead Author

Topics

  • Lifestyle Issues: Sleep/Diet/Exercise/Social Interactions