Moerkerke Matthijs, Vyverman Joren, De Baere Robrecht, Clement Patricia, Smeets Tom, Coppieters Iris, Timmers Inge, Van Oosterwijck Jessica
Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Pain in Motion International Research Consortium.
PLoS One. 2025 Jun 24;20(6):e0324089. doi: 10.1371/journal.pone.0324089. eCollection 2025.
Stress is suggested to be an important factor contributing to the development and persistence of musculoskeletal pain. Although stress and pain interactions are well known, it remains largely unclear how (dys)function of the major stress systems (i.e., the autonomic nervous system and the hypothalamic-pituitary-adrenal axis) contributes to pain extent and duration, and what the underlying mechanisms are. A comprehensive characterization of the stress systems and their interactions with pain is needed to better understand how stress confers vulnerability for persistent pain.
The primary aim of this study is to characterize stress system (dys)functioning (i.e., including basal levels, reactivity and recovery to acute stress, and chronic stress levels) in musculoskeletal pain groups with varying pain duration and extent, and to investigate the interaction between stress and pain at the psychosocial, (psycho)physiological and neural level. The secondary aim is to define the contribution of stress to pain trajectories, including chronification and recovery.
A study with a cross-sectional and a longitudinal arm will be conducted in musculoskeletal pain groups with varying pain characteristics, including chronic widespread pain (fibromyalgia), chronic and subacute localized pain (low back pain), and pain-free controls (n = 35/group). To characterize pain trajectories (recovery/persisting), localized pain groups will be reassessed after six months. Stress and pain characteristics and functionality will be assessed using questionnaires, autonomic measures (alpha-amylase, blood pressure, heart rate, respiratory rate, skin conductance and skin temperature), hormonal concentrations (cortisol and oxytocin), quantitative sensory testing (pain thresholds, pain tolerances, conditioned pain modulation and temporal summation of pain), and magnetic resonance imaging (brain structure and function).
This study will provide crucial insights in the role of stress in the extent of pain symptomatology and in conferring risk for pain chronicity. Additionally, it will shed light on the underlying mechanisms of stress and pain interactions. Trial registration: ClinicalTrials.gov (NCT06892977).
压力被认为是导致肌肉骨骼疼痛发生和持续存在的一个重要因素。尽管压力与疼痛之间的相互作用已为人熟知，但主要压力系统（即自主神经系统和下丘脑 - 垂体 - 肾上腺轴）的（功能）失调如何影响疼痛程度和持续时间，以及潜在机制是什么，在很大程度上仍不清楚。需要对压力系统及其与疼痛的相互作用进行全面表征，以更好地理解压力如何使人易患持续性疼痛。
本研究的主要目的是对不同疼痛持续时间和程度的肌肉骨骼疼痛组中的压力系统（功能）失调情况（即包括基础水平、对急性压力的反应性和恢复情况以及慢性压力水平）进行表征，并研究压力与疼痛在心理社会、（心理）生理和神经层面的相互作用。次要目的是确定压力对疼痛轨迹的影响，包括慢性化和恢复情况。
将对具有不同疼痛特征的肌肉骨骼疼痛组进行一项包含横断面和纵向研究的试验，这些疼痛组包括慢性广泛性疼痛（纤维肌痛）、慢性和亚急性局部疼痛（腰痛）以及无疼痛对照组（每组n = 35）。为了表征疼痛轨迹（恢复/持续），局部疼痛组将在六个月后重新评估。将使用问卷、自主神经测量指标（α - 淀粉酶、血压、心率、呼吸频率、皮肤电导率和皮肤温度）、激素浓度（皮质醇和催产素）、定量感觉测试（疼痛阈值、疼痛耐受性、条件性疼痛调制和疼痛的时间总和）以及磁共振成像（脑结构和功能）来评估压力和疼痛特征及功能。
本研究将为压力在疼痛症状程度中的作用以及导致疼痛慢性化的风险提供关键见解。此外，它将揭示压力与疼痛相互作用的潜在机制。试验注册：ClinicalTrials.gov（NCT06892977）。
