Cardiovascular Responses to an Acute Psychological Stressor Are Associated with the Cortisol Awakening Response in Individuals with Chronic Neck Pain

Overview

Journal Physiol Behav

Specialties Physiology
Psychiatry
Psychology
Social Sciences

Date 2015 Feb 10

PMID 25662023

Citations 4

Authors

Bahar Shahidi

Timothy Sannes

Mark Laudenslager

Katrina S Maluf

Affiliations

Soon will be listed here.

Abstract

Introduction: Dysregulation of the hypothalamic-pituitary-adrenal axis (HPA-axis) is common in individuals who experience chronic psychological stress, as well as individuals with chronic pain. Changes in cortisol availability in the presence of a chronic stressor such as pain may influence the sympathetic-adrenal-medullary (SAM) system, which contributes to cardiovascular responses to stress and also exhibits altered responsiveness in the presence of pain. The purpose of this study was to investigate the relationship between HPA activity during the cortisol awakening response and cardiovascular reactivity during exposure to an acute psychological stressor in individuals with chronic neck pain.

Methods: Area under the curve (AUC) of the salivary cortisol awakening response was assessed in 41 individuals with chronic neck pain aged 19-80 years (22 men, 23 women). Slopes representing the change in mean arterial pressure and heart rate during a baseline quiet sitting condition, a low stress condition with mental concentration, and a high stress condition combining mental concentration with social evaluative threat were calculated for each individual as an index of cardiovascular responsiveness to the acute stressor. Cardiovascular responses were regressed on cortisol awakening AUC and pain duration, adjusting for age and sex.

Results: Greater mean arterial pressure (β = -0.33, p = 0.02) and heart rate responses (β = -0.41, p = 0.007) to the acute psychological stressor were associated with lower cortisol awakening responses after adjusting for age and sex. Individuals with a shorter duration of chronic pain also demonstrated a larger increase in mean arterial pressure during the laboratory stressor (β = -0.39, p = 0.01), but there was no relationship between pain duration and changes in heart rate (p = 0.25).

Conclusions: Individuals with a shorter duration of chronic neck pain who demonstrate heightened cardiovascular responsiveness to an acute psychological stressor also exhibit lower cortisol awakening response. These results are consistent with time-dependent adaptations across the two major stress systems in the presence of chronic pain.

Citing Articles

Association of autonomic regulation with pain and disability in patients with chronic neck pain: a systematic review.

Afshan A, Iram I, Tanwar T, Rehman S, Zahid L, Veqar Z Rev Assoc Med Bras (1992). 2025; 71(1):e20240597.

PMID: 39775818 PMC: 11656537. DOI: 10.1590/1806-9282.20240597.

Persistent inflammatory pain is linked with anxiety-like behaviors, increased blood corticosterone, and reduced global DNA methylation in the rat amygdala.

Spinieli R, Cazuza R, Sales A, Carolino R, Martinez D, Anselmo-Franci J Mol Pain. 2022; 18:17448069221121307.

PMID: 35974687 PMC: 9393577. DOI: 10.1177/17448069221121307.

Smart Sensor Based on Biofeedback to Measure Child Relaxation in Out-of-Home Care.

Jaramillo-Quintanar D, Cruz-Albarran I, Guzman-Sandoval V, Morales-Hernandez L Sensors (Basel). 2020; 20(15).

PMID: 32731523 PMC: 7435878. DOI: 10.3390/s20154194.

Chronic Pain and Chronic Stress: Two Sides of the Same Coin?.

Abdallah C, Geha P Chronic Stress (Thousand Oaks). 2017; 1.

PMID: 28795169 PMC: 5546756. DOI: 10.1177/2470547017704763.

Why Harmless Sensations Might Hurt in Individuals with Chronic Pain: About Heightened Prediction and Perception of Pain in the Mind.

Hechler T, Endres D, Thorwart A Front Psychol. 2016; 7:1638.

PMID: 27826271 PMC: 5078757. DOI: 10.3389/fpsyg.2016.01638.

References

Sacco M, Meschi M, Regolisti G, Detrenis S, Bianchi L, Bertorelli M . The relationship between blood pressure and pain. J Clin Hypertens (Greenwich). 2013; 15(8):600-5. PMC: 8033897. DOI: 10.1111/jch.12145. View

Conway A, Kane M, Bunting M, Hambrick D, Wilhelm O, Engle R . Working memory span tasks: A methodological review and user's guide. Psychon Bull Rev. 2006; 12(5):769-86. DOI: 10.3758/bf03196772. View

Maixner W, Fillingim R, Kincaid S, Sigurdsson A, Harris M . Relationship between pain sensitivity and resting arterial blood pressure in patients with painful temporomandibular disorders. Psychosom Med. 1997; 59(5):503-11. DOI: 10.1097/00006842-199709000-00007. View

Buijs R . The autonomic nervous system: a balancing act. Handb Clin Neurol. 2013; 117:1-11. DOI: 10.1016/B978-0-444-53491-0.00001-8. View

Perry F, Heller P, Kamiya J, Levine J . Altered autonomic function in patients with arthritis or with chronic myofascial pain. Pain. 1989; 39(1):77-84. DOI: 10.1016/0304-3959(89)90177-2. View

Karlamangla A, Friedman E, Seeman T, Stawksi R, Almeida D . Daytime trajectories of cortisol: demographic and socioeconomic differences--findings from the National Study of Daily Experiences. Psychoneuroendocrinology. 2013; 38(11):2585-97. PMC: 3812359. DOI: 10.1016/j.psyneuen.2013.06.010. View

Lloyd D, Findlay G, Roberts N, Nurmikko T . Illness behavior in patients with chronic low back pain and activation of the affective circuitry of the brain. Psychosom Med. 2014; 76(6):413-21. DOI: 10.1097/PSY.0000000000000076. View

Vernon H, Mior S . The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991; 14(7):409-15. View

Guzman J, Haldeman S, Carroll L, Carragee E, Hurwitz E, Peloso P . Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations. J Manipulative Physiol Ther. 2009; 32(2 Suppl):S227-43. DOI: 10.1016/j.jmpt.2008.11.023. View

10.

Huang C, Webb H, Zourdos M, Acevedo E . Cardiovascular reactivity, stress, and physical activity. Front Physiol. 2013; 4:314. PMC: 3819592. DOI: 10.3389/fphys.2013.00314. View

11.

Uchino B, Cacioppo J, Malarkey W, Glaser R . Individual differences in cardiac sympathetic control predict endocrine and immune responses to acute psychological stress. J Pers Soc Psychol. 1995; 69(4):736-43. DOI: 10.1037//0022-3514.69.4.736. View

12.

Mishra G, Kuh D . Health symptoms during midlife in relation to menopausal transition: British prospective cohort study. BMJ. 2012; 344:e402. PMC: 3275131. DOI: 10.1136/bmj.e402. View

13.

Hannibal K, Bishop M . Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014; 94(12):1816-25. PMC: 4263906. DOI: 10.2522/ptj.20130597. View

14.

Richardson Morton K, Van de Kar L, Brownfield M, Lorens S, Napier T, Urban J . Stress-induced renin and corticosterone secretion is mediated by catecholaminergic nerve terminals in the hypothalamic paraventricular nucleus. Neuroendocrinology. 1990; 51(3):320-7. DOI: 10.1159/000125356. View

15.

Torpy D, Papanicolaou D, Lotsikas A, Wilder R, Chrousos G, Pillemer S . Responses of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis to interleukin-6: a pilot study in fibromyalgia. Arthritis Rheum. 2000; 43(4):872-80. DOI: 10.1002/1529-0131(200004)43:4<872::AID-ANR19>3.0.CO;2-T. View

16.

Ariens G, van Mechelen W, Bongers P, Bouter L, van der Wal G . Psychosocial risk factors for neck pain: a systematic review. Am J Ind Med. 2001; 39(2):180-93. DOI: 10.1002/1097-0274(200102)39:2<180::aid-ajim1005>3.0.co;2-#. View

17.

Hale G, Robertson D, Burger H . The perimenopausal woman: endocrinology and management. J Steroid Biochem Mol Biol. 2013; 142:121-31. DOI: 10.1016/j.jsbmb.2013.08.015. View

18.

Balter J, Molner J, Kohrt W, Maluf K . Mechanical pain sensitivity and the severity of chronic neck pain and disability are not modulated across the menstrual cycle. J Pain. 2013; 14(11):1450-9. PMC: 3865992. DOI: 10.1016/j.jpain.2013.07.008. View

19.

Cote P, van der Velde G, Cassidy J, Carroll L, Hogg-Johnson S, Holm L . The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976). 2008; 33(4 Suppl):S60-74. DOI: 10.1097/BRS.0b013e3181643ee4. View

20.

Generaal E, Vogelzangs N, Macfarlane G, Geenen R, Smit J, Penninx B . Reduced hypothalamic-pituitary-adrenal axis activity in chronic multi-site musculoskeletal pain: partly masked by depressive and anxiety disorders. BMC Musculoskelet Disord. 2014; 15:227. PMC: 4109382. DOI: 10.1186/1471-2474-15-227. View