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Opposite Effects of Stress on Pain Modulation Depend on the Magnitude of Individual Stress Response

  • Nirit Geva
    Affiliations
    Department of Physical Therapy and Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    Search for articles by this author
  • Ruth Defrin
    Correspondence
    Address reprint requests to Ruth Defrin, PhD, Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 69978, Israel.
    Affiliations
    Department of Physical Therapy and Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    Search for articles by this author
Published:December 11, 2017DOI:https://doi.org/10.1016/j.jpain.2017.11.011

      Highlights

      • Stress induced decrease in conditioned pain modulation (CPM) and increase in pain adaptation.
      • Decreased CPM occurred only among high stress responders.
      • Increased pain adaptation occurred only among low stress responders.
      • Acute stress affects pain modulation according to Individual stress responsiveness.

      Abstract

      The effect of acute stress on pain threshold and intolerance threshold are reported as producing either hypoalgesia or hyperalgesia. Yet, the contribution of individual stress reactivity in this respect has not been established. The aim was to test 2 pain modulation paradigms under acute stress manipulation, to our knowledge, for the first time, to study whether stress differentially affects pain modulation, and whether the effect is related to individual stress response. Participants were 31 healthy subjects. Conditioned pain modulation (CPM) and pain adaptation were measured before and after inducing an acute stress response using the Montreal Imaging Stress Task. Subjects' stress response was evaluated according to salivary cortisol, autonomic function, and perceived stress and anxiety. The Montreal Imaging Stress Task induced a validated stress response. On a group level, stress induced reduction in CPM magnitude and increase in pain adaptation compared with baseline. These responses correlated with stress reactivity. When the group was subdivided according to stress reactivity, only high stress responders exhibited reduced CPM whereas only low stress responders exhibited increased pain adaptation. The results suggest that acute stress may induce opposite effects on pain modulation, depending on individual stress reactivity magnitude, with an advantage to low stress responders.

      Perspective

      This study evaluated the effect of acute stress on pain modulation. Pain modulation under stress is affected by individual stress responsiveness; decreased CPM occurs in high stress responders whereas increased pain adaptation occurs in low stress responders. Identification of high stress responders may promote better pain management.

      Key words

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