Background & Aims

The relationship between stress and pain is complex, with some studies suggesting stress-induced analgesia (i.e., a decrease in pain in response to a stressor) [1-4] and others showing stress-induced hyperalgesia (i.e., an increase in pain in response to a stressor) [5-9]. One possible explanation for this variability is the individual’s perception of stress, which can subsequently impact their sensitivity to pain during stressful situations. The present study examined the relationship between self-reported perceived stress and pain sensitivity measured using quantitative sensory testing (QST) in participants with and without chronic low back pain (CLBP).

Methods

Participants (N=108) completed QST measuring pressure pain threshold (PPTh) and tolerance (PPTol), temporal summation of pain (TSP), and conditioned pain modulation (CPM) [10]. These assessments were conducted both before and after exposure to neurophysiological tests, the Stroop Color and Word Test (SCWT) [11-12] and the Mental Arithmetic Task (MAT) [13], which were employed to induce acute stress. Participants were categorized into three groups based on their perceived stress scores during the SCWT and MAT: 1) low (scores below the median for both tasks), 2) moderate (scores equal to or above the median for one of the tasks), and 3) high responders (scores equal to or above the median for both tasks). Controlling for CLBP status, repeated measures of analyses of variance (RM-ANOVAs) were conducted, with time (baseline and follow-up) as the within subject factor, group (low, moderate, and high responders) as the between-subjects factor, and groupxtime as the interaction term.

Results

Results from RM-ANOVAs analyses revealed no significant group differences in PPTh or PPTol assessed at the thumb and trapezius from baseline to follow-up. Nevertheless, high-stress responders reported greater pain during the PPTol task at follow-up when compared to the low or moderate stress responders. High-stress responders also showed trends towards enhanced TSP and less efficient CPM in response to acute stress, in contrast to their low or moderate stress responder counterparts.

Conclusions

Our findings suggest that individual differences in perceived stress levels in response to acute stressors may impact the experience of pain, highlighting the need for further exploration into the mechanisms underlying stress-pain relationships. Future research may provide insights into tailoring interventions for individuals with varying stress responses to improve pain management and overall well-being.

References

1.Bodnar RJ, Kelly DD, Brutus M, Glusman M. Stress-induced analgesia: Neural and hormonal determinants. Neurosci Biobehav Rev. 1980;4(1):87-100. doi:10.1016/0149-7634(80)90028-7.
2.Butler RK, Finn DP. Stress-induced analgesia. Prog Neurobiol. 2009;88(3):184-202. doi:10.1016/j.pneurobio.2009.04.003.
3.Costa A, Smeraldi A, Tassorelli C, Greco R, Nappi G. Effects of acute and chronic restraint stress on nitroglycerin-induced hyperalgesia in rats. Neurosci Lett. 2005;383(1):7-11. doi:10.1016/j.neulet.2005.03.026.
4.Flor H, Birbaumer N, Schulz R, Grüsser SM, Mucha RF. Pavlovian conditioning of opioid and nonopioid pain inhibitory mechanisms in humans. Eur J Pain. 2002;6(5):395-402. doi:10.1016/S1090-3801(02)00043-5.
5.Jennings EM, Okine BN, Roche M, Finn DP. Stress-induced hyperalgesia. Prog Neurobiol. 2014;121:1-18. doi:10.1016/j.pneurobio.2014.06.003.
6.Rivat C, Laboureyras E, Laulin J. Non-Nociceptive Environmental Stress Induces Hyperalgesia, Not Analgesia, in Pain and Opioid-Experienced Rats | Neuropsychopharmacology. Neuropsychopharmacol. 2007;32:2217-2228.
7.Jørum E. Analgesia or hyperalgesia following stress correlates with emotional behavior in rats. Pain. 1988;32(3):341-348. doi:10.1016/0304-3959(88)90046-2.
8.Gibbons CH, Adler GK, Bonyhay I, Freeman R. Experimental hypoglycemia is a human model of stress-induced hyperalgesia. PAIN®. 2012;153(11):2204-2209. doi:10.1016/j.pain.2012.06.030.
9.Choi JC, Chung MI, Lee YD. Modulation of pain sensation by stress-related testosterone and cortisol. Anaesthesia. 2012;67(10):1146-1151. doi:10.1111/j.1365-2044.2012.07267.
10.Edwards RR, Campbell C, Schreiber KL, et al. Multimodal prediction of pain and functional outcomes 6 months following total knee replacement: a prospective cohort study. BMC Musculoskelet Disord. 2022;23(1):302. doi:10.1186/s12891-022-05239-3.
11.Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;18(6):643-662. doi:10.1037/h0054651.
12.Renaud P, Blondin JP. The stress of Stroop performance: physiological and emotional responses to color–word interference, task pacing, and pacing speed. Int J Psychophysiol. 1997;27(2):87-97. doi:10.1016/S0167-8760(97)00049-4.
13.Liao LM, Carey MG. Laboratory-induced Mental Stress, Cardiovascular Response, and Psychological Characteristics. Rev Cardiovasc Med. 2015;Volume 16(No. 1). Accessed September 7, 2023. https://read.nxtbook.com/medreviews/reviewscardiovascularmedicine/volume16no1/systematicreview_laboratory.html.

Presenting Author

Jihee Yoon

Poster Authors

JiHee Yoon

MSc

Mass General Brigham

Lead Author

E-mail

Josephine Issenmana

MSc

New York Medical College

Lead Author

E-mail

Gabriela Comptdaer

MSc

Boston University School of Medicine

Lead Author

E-mail

Claire E Lunde

University of Oxford

Lead Author

E-mail

Robert Edwards

PhD

Brigham & Women's Hospital/Harvard Medical School

Lead Author

E-mail

Christine Sieberg

Harvard University

Lead Author

E-mail

SAMANTHA MEINTS

PhD

Dept. of Anesthesiology, Perioperative & Pain Medicine, Brigham & Women’s Hospital, Boston, MA, USA

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial