在患有慢性颈部疼痛的个体中，对急性心理应激源的心血管反应与皮质醇觉醒反应相关。
Cardiovascular responses to an acute psychological stressor are associated with the cortisol awakening response in individuals with chronic neck pain.
作者信息
Shahidi Bahar, Sannes Timothy, Laudenslager Mark, Maluf Katrina S
机构信息
University of Colorado Denver, Rehabilitation Science Program, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA.
University of Colorado Denver, Department of Psychiatry, Aurora, CO, USA.
出版信息
Physiol Behav. 2015 Oct 15;150:93-8. doi: 10.1016/j.physbeh.2015.02.010. Epub 2015 Feb 7.
INTRODUCTION
Dysregulation of the hypothalamic-pituitary-adrenal axis (HPA-axis) is common in individuals who experience chronic psychological stress, as well as individuals with chronic pain. Changes in cortisol availability in the presence of a chronic stressor such as pain may influence the sympathetic-adrenal-medullary (SAM) system, which contributes to cardiovascular responses to stress and also exhibits altered responsiveness in the presence of pain. The purpose of this study was to investigate the relationship between HPA activity during the cortisol awakening response and cardiovascular reactivity during exposure to an acute psychological stressor in individuals with chronic neck pain.
METHODS
Area under the curve (AUC) of the salivary cortisol awakening response was assessed in 41 individuals with chronic neck pain aged 19-80 years (22 men, 23 women). Slopes representing the change in mean arterial pressure and heart rate during a baseline quiet sitting condition, a low stress condition with mental concentration, and a high stress condition combining mental concentration with social evaluative threat were calculated for each individual as an index of cardiovascular responsiveness to the acute stressor. Cardiovascular responses were regressed on cortisol awakening AUC and pain duration, adjusting for age and sex.
RESULTS
Greater mean arterial pressure (β = -0.33, p = 0.02) and heart rate responses (β = -0.41, p = 0.007) to the acute psychological stressor were associated with lower cortisol awakening responses after adjusting for age and sex. Individuals with a shorter duration of chronic pain also demonstrated a larger increase in mean arterial pressure during the laboratory stressor (β = -0.39, p = 0.01), but there was no relationship between pain duration and changes in heart rate (p = 0.25).
CONCLUSIONS
Individuals with a shorter duration of chronic neck pain who demonstrate heightened cardiovascular responsiveness to an acute psychological stressor also exhibit lower cortisol awakening response. These results are consistent with time-dependent adaptations across the two major stress systems in the presence of chronic pain.
引言
下丘脑 - 垂体 - 肾上腺轴（HPA轴）功能失调在经历慢性心理压力的个体以及慢性疼痛患者中很常见。在存在诸如疼痛等慢性应激源的情况下，皮质醇可用性的变化可能会影响交感 - 肾上腺 - 髓质（SAM）系统，该系统有助于心血管对压力的反应，并且在存在疼痛时也表现出反应性改变。本研究的目的是调查慢性颈部疼痛患者在皮质醇觉醒反应期间的HPA活动与暴露于急性心理应激源期间的心血管反应性之间的关系。
方法
对41名年龄在19 - 80岁之间的慢性颈部疼痛患者（22名男性，23名女性）进行唾液皮质醇觉醒反应的曲线下面积（AUC）评估。计算每个个体在基线安静坐姿、精神集中的低压力状态以及精神集中与社会评价威胁相结合的高压力状态下平均动脉压和心率变化的斜率，作为心血管对急性应激源反应性的指标。将心血管反应与皮质醇觉醒AUC和疼痛持续时间进行回归分析，并对年龄和性别进行校正。
结果
在对年龄和性别进行校正后，对急性心理应激源的更大平均动脉压反应（β = -0.33，p = 0.02）和心率反应（β = -0.41，p = 0.007）与较低的皮质醇觉醒反应相关。慢性疼痛持续时间较短的个体在实验室应激源期间平均动脉压也有更大的升高（β = -0.39，p = 0.01），但疼痛持续时间与心率变化之间没有关系（p = 0.25）。
结论
慢性颈部疼痛持续时间较短且对急性心理应激源表现出较高心血管反应性的个体也表现出较低的皮质醇觉醒反应。这些结果与在存在慢性疼痛时两个主要应激系统随时间的适应性变化一致。
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