Cardiovascular responses to an acute psychological stressor are associated with the cortisol awakening response in individuals with chronic neck pain

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.

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

“…18 Similarly, data from our group showed an anxiogenic-like response observed in the EPM 10 days after orofacial CFA injection. 17 There exist conflicting data of how chronic pain and stress hormones (e.g., corticosterone and/or adrenocorticotropic hormone, ACTH) are linked, with reports of increased, [20][21][22][23] decreased, [24][25][26] or unchanged [27][28][29] blood corticosterone or ACTH levels in subjects with chronic pain. We propose two explanations for such seemingly contradictory findings.…”

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

“…22,[26][27][28] Second, the data on the ''dysregulation of the HPA axis and cortisol'' level in chronic pain does not fit any clear consistent pattern. As such, studies of chronic pain conditions have reported increases 6,[114][115][116][117][118][119] and decreases 41,[120][121][122][123][124] in cortisol level, while many studies reported no changes. [125][126][127][128] Furthermore, different reports present conflicting data within the same condition such as CBP, 6,41 fibromyalgia, 125,129 or migraine.…”

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“…This imbalance might downregulate the HPA-axis resulting in chronic hypercortisolemia (Barrett and Simmons, 2015), indicative of a permanently altered stress response. Dysregulation of the HPA-axis have been found in individuals with chronic pain (Fukudo, 2013; Shahidi et al, 2015) but have not yet been investigated in the context of altered interoceptive predictions.…”