Geva Nirit, Pruessner Jens, Defrin Ruth
Department of Physical Therapy and Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Douglas Mental Health Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
Pain. 2014 Nov;155(11):2418-25. doi: 10.1016/j.pain.2014.09.023. Epub 2014 Sep 22.
Anecdotes on the ability of individuals to continue to function under stressful conditions despite injuries causing excruciating pain suggest that acute stress may induce analgesia. However, studies exploring the effect of acute experimental stress on pain perception show inconsistent results, possibly due to methodological differences. Our aim was to systematically study the effect of acute stress on pain perception using static and dynamic, state-of-the-art pain measurements. Participants were 29 healthy men who underwent the measurement of heat-pain threshold, heat-pain intolerance, temporal summation of pain, and conditioned pain modulation (CPM). Testing was conducted before and during exposure to the Montreal Imaging Stress Task (MIST), inducing acute psychosocial stress. Stress levels were evaluated using perceived ratings of stress and anxiety, autonomic variables, and salivary cortisol. The MIST induced a significant stress reaction. Although pain threshold and pain intolerance were unaffected by stress, an increase in temporal summation of pain and a decrease in CPM were observed. These changes were significantly more robust among individuals with stronger reaction to stress ("high responders"), with a significant correlation between the perception of stress and the performance in the pain measurements. We conclude that acute psychosocial stress seems not to affect the sensitivity to pain, however, it significantly reduces the ability to modulate pain in a dose-response manner. Considering the diverse effects of stress in this and other studies, it appears that the type of stress and the magnitude of its appraisal determine its interactions with the pain system.
关于个体在受伤导致剧痛的压力条件下仍能继续发挥功能的轶事表明,急性应激可能会诱发镇痛作用。然而,探索急性实验性应激对疼痛感知影响的研究结果并不一致,这可能是由于方法上的差异。我们的目的是使用静态和动态的、最先进的疼痛测量方法,系统地研究急性应激对疼痛感知的影响。参与者为29名健康男性,他们接受了热痛阈值、热痛耐受度、疼痛的时间总和以及条件性疼痛调制(CPM)的测量。在暴露于蒙特利尔成像应激任务(MIST)之前和期间进行测试,该任务会诱发急性心理社会应激。使用应激和焦虑的感知评分、自主变量以及唾液皮质醇来评估应激水平。MIST诱发了显著的应激反应。尽管疼痛阈值和疼痛耐受度不受应激影响,但观察到疼痛的时间总和增加,CPM降低。在对应激反应较强的个体(“高反应者”)中,这些变化更为显著,应激感知与疼痛测量表现之间存在显著相关性。我们得出结论,急性心理社会应激似乎不会影响对疼痛的敏感性,然而,它会以剂量反应的方式显著降低调节疼痛的能力。考虑到本研究及其他研究中应激的多种效应,似乎应激的类型及其评估程度决定了它与疼痛系统的相互作用。