Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Surg Res. 2022 Feb;270:286-292. doi: 10.1016/j.jss.2021.08.040. Epub 2021 Oct 28.
The relationship between pain and stress is widely accepted, yet the underlying neuroendocrine mechanisms are poorly understood. Cortisol secretion during a stress response, may distract attention from a painful stimulus, inhibiting pain. However, when pain is the stressor, cortisol secretion may intensify the pain experience and condition a fear-based memory of pain. This study attempts to determine the relationship between acute pain, chronic pain, and cortisol in the traumatically injured population.
Secondary analyses of a prospective observational study with participants from a Midwestern Adult Level I Trauma Center post traumatic injury, with interview and serum cortisol taken at hospitalization (baseline) and 6 mo after discharge, was completed using Ward's Method hierarchical cluster analysis, Pearson's correlations, and linear regressions.
Two major clusters were identified. The Chronic Pain group were those who had severe pain at discharge and continued to have severe pain as defined by Numeric Pain Score. The Resolved Pain group were those who had moderate pain at discharge and their pain improved or resolved. Pain score at discharge significantly, negatively correlated with baseline cortisol levels (r = -0.142, P = 0.02). Minority status, single individuals, low cortisol at baseline, and greater psychological distress at baseline significantly increased the likelihood of developing chronic pain.
Low cortisol and greater psychological stress, which are also associated with minority status and single individuals, contribute to chronic pain in the traumatically injured population. Trauma victims without an adequate cortisol response to acute injury and pain are at risk for development of chronic pain after injury.
疼痛和压力之间的关系已被广泛接受，但潜在的神经内分泌机制仍知之甚少。应激反应期间皮质醇的分泌可能会分散对疼痛刺激的注意力，从而抑制疼痛。然而，当疼痛成为应激源时，皮质醇的分泌可能会加剧疼痛体验，并形成对疼痛的基于恐惧的记忆。本研究试图确定创伤人群中急性疼痛、慢性疼痛和皮质醇之间的关系。
对中西部成人一级创伤中心创伤后患者进行前瞻性观察性研究的二次分析，在住院时（基线）和出院后 6 个月进行访谈和血清皮质醇采集，采用 Ward 方法层次聚类分析、Pearson 相关分析和线性回归进行分析。
确定了两个主要聚类。慢性疼痛组是指出院时疼痛严重且按数字疼痛评分定义仍持续严重疼痛的患者。缓解疼痛组是指出院时疼痛中度且疼痛改善或缓解的患者。出院时的疼痛评分与基线皮质醇水平显著负相关（r=-0.142，P=0.02）。少数民族、单身、基线时皮质醇水平较低和基线时心理困扰较大显著增加了发生慢性疼痛的可能性。
皮质醇水平较低和心理压力较大，这也与少数民族和单身个体有关，导致创伤人群中出现慢性疼痛。创伤后急性损伤和疼痛时皮质醇反应不足的创伤患者，在受伤后有发展为慢性疼痛的风险。
