Exploring the Allostatic Load of Pain, Interference, and the Buffering of Resilience

Abstract

Chronic pain contributes to allostatic load (AL). Individuals with protective psychosocial and biobehavioral factors report lower levels of clinical pain. We have previously shown a relationship between a resilience index, telomere length, and brain structure. This study aims to assess the relationships between AL, a resilience index, and clinical pain/interference. In this study, 193 Non-Hispanic Black and non-Hispanic White adults 45-85 years old, with/without knee pain participated. Data collected included sociodemographics, health history, Graded Chronic Pain Scale (GCPS), and blood samples. AL score was determined by a high risk value of 1 for each measure in the upper quartile for systolic blood pressure, diastolic blood pressure, waist-to-hip ratio, heart rate, fibrinogen, c-reactive protein, and cortisol, and the lower quartile for insulin-like growth factor-1, albumin, and dehydroepiandrosterone (0-10 score). The resilience index was comprised of tobacco use, waist-to-hip ratio, optimism, affect, active coping, perceived stress, and social support. Two-level scoring was used based on clinical norms or median split with higher scores indicating greater resilience (0-8 score). Spearman correlations and adjusted regression analyses were completed using SAS V 9.4. Resilience was inversely associated with GCPS Intensity (rs=-0.26, p=0.0004) and Interference (rs=-0.32, p<0.0001). GCPS Intensity (coefficient=0.16856, p=0.0198) and Interference (r=0.23978, p=0.0008) were positively associated with AL. The resilience index (t=-2.07, p=0.0395) was predictive of AL in an adjusted analysis including age, sex, and ethnicity/race but was not significant when including GCPS Intensity or interference. Resilience was associated with pain and AL, however a biological buffering effect for pain was not demonstrated. AL is a more dynamic measure than telomere length. Additionally, the current AL composite is relative to the sample, a clinically validated measure may be more informative. Further development and refinement of a biologically sensitive resilience index would have significant clinical utility. Grant support from National Institutes of Health/National Institute on Aging [R01AG054370; R37AG033906; T32AG049673; P30 AG059297-01]; the University of Florida Clinical and Translational Science Institute [UL1TR000064]; the University of Alabama at Birmingham Center for Clinical and Translational Science Institute [UL1TR000165] and the Inter-NIA Center Pilot Proposals on Life Course Perspectives on Aging and Resilience and Reserve in Aging.