Autonomic activation and pain in response to low-grade mental stress in fibromyalgia and shoulder/neck pain patients

Abstract

Objective Psychosocial stress is a risk factor for musculoskeletal pain, but how stress affects musculoskeletal pain is poorly understood. We wanted to examine the relationship between low-grade autonomic activation and stress-related pain in patients with fibromyalgia and localised chronic shoulder/neck pain. Methods Twenty-three female patients with fibromyalgia, 29 female patients with chronic shoulder–neck pain, and 35 healthy women performed a stressful task lasting 60 min. With a blinded study design, we recorded continuous blood pressure, heart rate, finger skin blood flow and respiration frequency before (10 min), during (60 min) and after (30 min) the stressful task. The physiological responses were compared with subjective reports of pain. Results The increase in diastolic blood pressure and heart rate in response to the stressful task were smaller in fibromyalgia patients compared with the healthy controls. Furthermore, fibromyalgia patients had reduced finger skin blood flow at the end of the stressful task compared to healthy controls. We also found an inverse relationship between the heart rate response and development and recovery of the stress-related pain in fibromyalgia patients. Conclusion We found abnormal cardiovascular responses to a 60 min long stressful task in fibromyalgia patients. Furthermore, we found a negative association between the heart rate response and the pain which developed during the stressful task in the fibromyalgia group, possibly a result of reduced stress-induced analgesia for fibromyalgia patients.