Stress-induced hyperalgesia instead of analgesia in patients with chronic musculoskeletal pain

Review written by Dr Sandy Hilton info

Key Points

  1. An acute stressor leads to higher reported pain in those with chronic musculoskeletal pain (CMP) compared to controls.
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BACKGROUND & OBJECTIVE

Stress-induced analgesia (SIA) refers to an increased pain threshold, increased pain tolerance, and increased nociceptive withdrawal reflex thresholds in response to painful stimulation. Studies have shown that SIA responds to various physical stressors in humans along with increased pain thresholds and increased pain tolerance but decreased suprathreshold pain ratings to mechanical stimulation.

The authors designed this study to explore the hypoalgesic effects in controls compared to patients with chronic musculoskeletal pain (CMP). They looked at the effect of cognitive stress on pain.

The objectives were:

  1. To identify if SIA reduced in patients with CMP with a purely cognitive stressor.

  2. To identify if SIA reduced in patients with more widespread pain with this cognitive stressor

Stress-induced analgesia refers to an increased pain threshold, increased pain tolerance, and increased nociceptive withdrawal reflex thresholds in response to painful stimulation.
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Less stress may result in more overall tolerance, even for pain.

METHODS

Group 1: N=22 (15 women, 7 men) with chronic localized or widespread musculoskeletal back pain of > 3 months and current episode of pack pain of > 4 weeks prior to the experiment.

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