A low cortisol response to stress is associated with musculoskeletal pain combined with increased pain sensitivity in young adults: a longitudinal cohort study.

Markus Paananen,Darren Beales,Anne Smith,Jaro Karppinen,Leon Straker,Pieter Coenen,Craig Pennell,Peter O’Sullivan

doi:10.1186/s13075-015-0875-z

Abstract

BackgroundIn this study, we investigated whether an abnormal hypothalamic-pituitary-adrenal (HPA) axis response to psychosocial stress at 18 years of age is associated with musculoskeletal (MS) pain alone and MS pain combined with increased pain sensitivity at 22 years of age.MethodsThe study sample included 805 participants from the Western Australian Pregnancy Cohort (Raine) Study who participated in the Trier Social Stress Test (TSST) at age 18 years. Number of pain sites, pain duration, pain intensity and pain frequency were assessed at age 22 to measure severity of MS pain. Cold and pressure pain thresholds were determined at age 22. Group-based trajectory modeling was applied to establish cortisol response patterns based on the TSST. Logistic regression was used to study the association of TSST patterns with MS pain alone and MS pain combined with increased cold or pressure pain sensitivity, adjusted for relevant confounding factors. All analyses were stratified by sex.ResultsThe mean (standard deviation) age during the TSST was 18.3 (0.3) years, and during MS pain assessment it was 22.2 (0.6). Forty-five percent of the participants were female. Three cortisol response patterns were identified, with cluster 1 (34 % of females, 21 % of males) reflecting hyporesponse, cluster 2 (47 %, 54 %) reflecting intermediate response and cluster 3 (18 %, 24 %) reflecting hyperresponse of the HPA axis. MS pain was reported by 42 % of females and 33 % of males at age 22 years. Compared with females in cluster 2, females in cluster 1 had an increased likelihood of having any MS pain (odds ratio 2.3, 95 % confidence interval 1.0–5.0) and more severe MS pain (2.8, 1.1–6.8) if their cold pain threshold was above the median. In addition, females in cluster 1 had an increased likelihood (3.5, 1.3–9.7) of having more severe MS pain if their pressure pain threshold was below the median. No statistically significant associations were observed in males.ConclusionsThis study suggests that a hyporesponsive HPA axis at age 18 years is associated with MS pain at 22 years in young females with increased pain sensitivity.

Highlights

In this study, we investigated whether an abnormal hypothalamic-pituitary-adrenal (HPA) axis response to psychosocial stress at 18 years of age is associated with musculoskeletal (MS) pain alone and MS pain combined with increased pain sensitivity at 22 years of age
Musculoskeletal pain MS pain at any site was reported by 42 % of females and 33 % of males (Table 1)
cold pain threshold (CPT) was above the median in 54 % of females and 48 % of males with any pain, and in 59 % of females and 48 % of males with a high pain problem severity index

Summary

Introduction

We investigated whether an abnormal hypothalamic-pituitary-adrenal (HPA) axis response to psychosocial stress at 18 years of age is associated with musculoskeletal (MS) pain alone and MS pain combined with increased pain sensitivity at 22 years of age. There is growing evidence that relative hypocortisolism, as a marker of stress-induced HPA axis dysfunction, may in turn increase vulnerability to pain and chronic pain disorders [5, 8,9,10,11,12,13]. Pharmacologically induced hypocortisolism increased mechanical pain sensitivity and potentiated hyperalgesia in healthy males, suggesting that HPA axis alterations have a causal role in pain [5]. In a crosssectional study of female twins, a blunted cortisol diurnal pattern was associated with higher perceived pain intensity during a cold pressor test [13]

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