Stress-induced Physiologic Changes as a Basis for the Biopsychosocial Model of Chronic Musculoskeletal Pain (original) (raw)
2008, The Clinical Journal of Pain
(1) To integrate the scientific literatures of the biopsychosocial model of chronic musculoskeletal pain and of stress-induced physiologic wound and muscle changes, and (2) to propose a clinical assessment and treatment model that incorporates this dual literature into the management of chronic musculoskeletal pain. English language literature search from January 1990 to February 2008 using the MEDLINE and PsycINFO databases and the keywords "wound healing," "musculoskeletal injury," "skeletal muscle injury," "psychological," "social," "stress," "anxiety," and "pain." An illustrative case report is introduced. Review of the scientific literature revealed that psychologic stress is associated with slower or delayed wound healing in stressed older adults, restrained mice, socially isolated hamsters, adults with leg wounds, and surgical patients. One study showed that expressive writing positively affected the healing of a small skin puncture. Psychosocial stress affected aspects of muscle activity and spinal loading. Slaughter studies demonstrated that high preslaughter stress in pigs negatively affected postslaughter meat quality. A clinical model for the treatment of selected patients with painful musculoskeletal symptoms is offered. Important links exist between psychologic and social factors and recovery from insults to the "soft tissues." Identifiable biochemical and physiologic processes mediate this relationship. It is time to rethink and refine views of the role of psychologic and social factors in musculoskeletal illness, chronicity, and pain.
Related papers
On the relation of injury to pain the John J. Bonica Lecture
PAIN, 1979
Pain is better classified asan awareness of a need-state than as a sensation. It serves more to promote healing than to avoid injury. It has more in common with the phenomena of hunger and thirst than it has with seeing or hearing. The period after injury is divided into the immediate, acute and chronic stages. In each stage it is shown that pain has only a weak connection ~o injury but a strong connection to the body state.
Annals of the rheumatic diseases, 2015
Dysregulated biological stress systems and adverse life events, independently and in interaction, have been hypothesised to initiate chronic pain. We examine whether (1) function of biological stress systems, (2) adverse life events, and (3) their combination predict the onset of chronic multisite musculoskeletal pain. Subjects (n=2039) of the Netherlands Study of Depression and Anxiety, free from chronic multisite musculoskeletal pain at baseline, were identified using the Chronic Pain Grade Questionnaire and followed up for the onset of chronic multisite musculoskeletal pain over 6 years. Baseline assessment of biological stress systems comprised function of the hypothalamic-pituitary-adrenal axis (1-h cortisol awakening response, evening levels, postdexamethasone levels), the immune system (basal and lipopolysaccharide-stimulated inflammation) and the autonomic nervous system (heart rate, pre-ejection period, SD of the normal-to-normal interval, respiratory sinus arrhythmia). The...
Stress-induced hyperalgesia instead of analgesia in patients with chronic musculoskeletal pain
arXiv (Cornell University), 2019
Many individuals with chronic musculoskeletal pain (CMP) show impairments in their pain-modulatory capacity. Although stress plays an important role in chronic pain, it is not known if stress-induced analgesia (SIA) is affected in patients with CMP. We investigated SIA in 22 patients with CMP and 18 pain-free participants. Pain thresholds, pain tolerance and suprathreshold pain ratings were examined before and after a cognitive stressor that typically induces pain reduction (SIA). Whereas the controls displayed a significant increase in pain threshold in response to the stressor, the patients with CMP showed no analgesia. In addition, increased pain intensity ratings after the stressor indicated hyperalgesia (SIH) in the patients with CMP compared to controls. An exploratory analysis showed no significant association of SIA or SIH with spatial pain extent. We did not observe significant changes in pain tolerance or pain unpleasantness ratings after the stressor in patients with CMP or controls. Our data suggest that altered stress-induced pain modulation is an important mechanism involved in CMP. Future studies need to clarify the psychobiological mechanisms of these stress-induced alterations in pain processing and determine the role of contributing factors such as early childhood trauma, catastrophizing, comorbidity with mental disorders and genetic predisposition.
Chapter 6 psyChoneuroimmunologiCal aspeCts of wound healing and the role of pain
Key points in this chapter include: l Physiological aspects of wound repair l Psychoneuroimmunological factors on wound healing l Tissue type l Impact of gender, age and health behaviours on wound healing. As you are reading this there is a good chance that your body is undergoing some sort of healing, be it from a superficial paper cut or a surgical procedure. Your immune system plays a well-characterised role in any healing process; as such, psychological and behavioural factors that affect immune and neuroendocrine function — from psychological stress and mood to sleep patterns — influence healing as well. The clinical importance of research in this area is striking. Along with an increasing appreciation for the impact of psychosocial and behavioural factors on wound healing has come a greater understanding of the physiological mechanisms which connect such factors to healing outcomes (Engeland and Marucha, 2009). Research in this area will help to develop better models for predi...
Psychological stress and wound healing in humans: a systematic review and meta-analysis
Journal of …, 2009
Objective: The current review aims to synthesize existing knowledge about the relationship between psychological stress and wound healing. Methods: A systematic search strategy was conducted using electronic databases to search for published articles up to the end of October 2007. The reference lists of retrieved articles were inspected for further studies and citation searches were conducted. In addition, a meta-analysis of a subset of studies was conducted to provide a quantitative estimation of the influence of stress on wound healing. Results: Twenty-two papers met the inclusion criteria of the systematic review and a subsample of 11 was included in a meta-analysis. The studies assessed the impact of stress on the healing of a variety of wound types in different contexts, including acute and chronic clinical wounds, experimentally created punch biopsy and blister wounds, and minor damage to the skin caused by tape stripping. Seventeen studies in the systematic review reported that stress was associated with impaired healing or dysregulation of a biomarker related to wound healing. The relationship between stress and wound healing estimated by the meta-analysis was r=−0.42 (95% CI=−0.51 to −0.32) (Pb.01). Conclusion: Attention now needs to be directed towards investigating potential moderators of the relationship, mediating mechanisms underpinning the association, as well as the demonstration of a causal link by the development of experimental interventions in healthy populations.
Stress Associated with Orthopedic Surgery and Feeling Pain
Organizational Culture and Ethics in Modern Medicine, 2016
Injuries and degenerative disease of the skeletal and articular systems are the most common reasons for undergoing orthopaedic surgery. Those diseases are often associated with pain, which is experienced by the patient long before the surgical procedure. Strong stress reaction is the main source of adjustment disorders of patients undergoing surgical treatment. Orthopaedic surgery, like any other surgery, upsets body's homeostasis. The results of the surgery are not completely predictable, but are always closely related to life and health. Patients' strong stress reaction is also connected with anaesthesia (emergence from anaesthesia), being worried of complications caused by central neuraxial anaesthesia-the fear of paresis or death. The factor which influences worse adaptation process is the patients' post-surgery mood. Right after the surgery, patients feel worse than before it, they are weak, move less freely, they are anxious about their consciousness being dimmed due to medicine intake and pain. The expectations concerning the ways of controlling the dynamics of the pain one experiences are crucial. According to the researchers, in the central nervous system there exist neural circuits that may cause physiological reactions according to one's expectations, and due to this fact the pain one experiences may become stronger or alleviated depending on one's expectations. The lack of positive pain-reducing experience may lead to the learned helplessness or no sense of one's control over pain, both of which make the pain stronger. The pain-influencing factors include cognitive processes and emotions. The role of attention processes, one's cognitive appraisal and one's attitude towards pain has been emphasised, as well as the pain-modelling influence of emotions, all of which emphasise the complexity of one's pain experience.
Loading Preview
Sorry, preview is currently unavailable. You can download the paper by clicking the button above.
Related papers
Journal of Anesthesia & Critical Care: Open Access, 2016