Abstract
Pain and stress are both phenomena that challenge an individual’s homeostasis and have significant overlap in conceptual and physiological processes. Allostasis is the ability to adapt to pain and stress and maintain homeostasis; however, if either process becomes chronic, it may result in negative long-term outcomes. The negative effects of stress on health outcomes on physiology and behavior, including pain, have been well documented; however, the specific mechanisms of how stress and what quantity of stress contributes to the maintenance and exacerbation of pain have not been identified, and thus pharmacological interventions are lacking. The objective of this brief review is to: 1. identify the gaps in the literature on the impact of acute and chronic stress on chronic pain, 2. highlight future directions for stress and chronic pain research; and 3. introduce the Pain-Stress Model in the context of the current literature on stress and chronic pain. A better understanding of the connection between stress and chronic pain could provide greater insight into the neurobiology of these processes and contribute to individualized treatment for pain rehabilitation and drug development for these often comorbid conditions.
Highlights
Specialty section: This article was submitted to Neuropharmacology, a section of the journal Frontiers in NeuroscienceReceived: 20 December 2019 Accepted: 10 March 2020 Published: 26 March 2020Citation: Lunde CE and Sieberg CB (2020) Walking the Tightrope: A Proposed Model of Chronic Pain and Stress.Front
Animal models confirm the complexity of the relationship between chronic pain and stress
Further research is needed to translate these animal findings to clinical populations across ages, sex, and pain conditions. These animal models do not define how much stress is needed to contribute to pain presentation, nor do they define the specific impact of the timing, severity, or type of stress, and alternatively, if there is a healthy or protective dose of stress that could buffer or prevent the onset of chronic pain
Summary
Specialty section: This article was submitted to Neuropharmacology, a section of the journal Frontiers in Neuroscience. Results showed that mice displayed heterogeneous sensitivities in the chronic pain-induced anxiety- and depression-like behaviors of affective pain Their molecular analyses revealed that the mice with higher vulnerabilities to developing emotional disorders, such as depression and anxiety, revealed to have lower levels of protein in the amygdala, and in the emotion-processing central nucleus (Wang et al, 2017). Their findings suggest that individual vulnerabilities to pain may be ingrained in the emotional aspect of chronic pain and remain consistent in aspects of negative emotions, in which adaptive changes in the role of the changed protein levels in central amygdala may have significant and longterm consequences. A model of prolonged or intermittent restraint stress is important to consider when investigating the mechanisms linking stress and chronic pain, and could provide insight to assessing the potential therapeutic efficacy of drugs targeted against painful pathologies with co-morbid stress (Bardin et al, 2009)
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