Stress and Alterations in the Pain Matrix: A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment

Abstract

The genesis of chronic pain is explained by a biopsychosocial model. It hypothesizes an interdependency between environmental and genetic factors provoking aberrant long-term changes in biological and psychological regulatory systems. Physiological effects of psychological and physical stressors may play a crucial role in these maladaptive processes. Specifically, long-term demands on the stress response system may moderate central pain processing and influence descending serotonergic and noradrenergic signals from the brainstem, regulating nociceptive processing at the spinal level. However, the underlying mechanisms of this pathophysiological interplay still remain unclear. This paper aims to shed light on possible pathways between physical (exercise) and psychological stress and the potential neurobiological consequences in the genesis and treatment of chronic pain, highlighting evolving concepts and promising research directions in the treatment of chronic pain. Two treatment forms (exercise and mindfulness-based stress reduction as exemplary therapies), their interaction, and the dose-response will be discussed in more detail, which might pave the way to a better understanding of alterations in the pain matrix and help to develop future prevention and therapeutic concepts.

<p>Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain: A Prospective Longitudinal Study</p>

“…Psychosocial stress has a direct impact on both people´s health and pain processing. 3,7,8 Stress is an individual´s reaction to external or internal stressors activating psychological and physiological mechanisms, which prepare the individual to deal with an upcoming challenging situation. [9][10][11] Stressors that combine social evaluative threat and uncontrollability are powerful in activating stress reactivity systems.…”

“…7,13 These mechanisms are highly interrelated to pain processing. 7,8,11 For example, the occurrence of critical life events may elicit central changes in the limbic system and related neurotransmitters, which then alter descending signaling pathways and change pain inhibitory mechanisms. Chronic stress, on the other hand, and the resulting change of the body´s ability to maintain homeostasis may alter ascending signaling mechanisms and lead to decreased pain thresholds.…”

Personalized Treatment Suggestions: The Validity and Applicability of the Risk-Prevention-Index Social in Low Back Pain Exercise Treatments

“…After all, such effects can depend on the individual risk profile of a person on the one hand and on the reinforcing mechanisms of action of different therapy modules on the other. Regarding exercise therapy, there are indications that psychosocial factors may influence physiological exercise adaptation outcomes [12][13][14][15]. For example, it has been shown that the individual distress level influences the exercise dose-response effect on pain and depression outcomes, whereby a high exercise dose leads to worse outcomes because of additional high stress levels [16,17].…”

The Feasibility and Effectiveness of a New Practical Multidisciplinary Treatment for Low-Back Pain: A Randomized Controlled Trial

“…As it was shown that MBSR is powerful in increasing stress resilience [48], this association may additionally reinforce the intended pathways through the combination of exercise and distraction [49]. Because stress and pain stimuli are processed in the same brain areas, additional effects on central and peripheral sensitization may therefore be expected [14]. One component of the MBSR-the body scan-is a training unit in which participants focus on different parts of bodily awareness which was shortened to 10 minutes [50] and offered directly after the sensorimotor training.…”

“…Although addressing all the underlying components of LBP earlier in the chronification process may yield broader benefits for both patient and the health care systems, interdisciplinary therapies tend to only be available for patients in the advanced stages of LBP. Secondly, the widely accepted biopsychosocial model of chronic pain [13] not only suggests that biological, social, and psychological factors contribute to the development of chronic pain, but also that there are interactions between these dimensions [14]. Therefore, an interdisciplinary intervention that takes into account these interactions is likely to be more effective.…”