Salivary cortisol and psychological mechanisms in patients with acute versus chronic low back pain

Cortisol Awakening Response and Pain-Related Fear-Avoidance Versus Endurance in Patients Six Months After Lumbar Disc Surgery

“…Successfully withstanding paininduced interruptions in routine may decrease the level of psychological distress (Hasenbring and Verbunt 2010). The results of the present study support this notion of a shortterm positive consequence of pain-related persistence and are in line with previous findings from a sample of patients with non-specific low back pain (Sudhaus et al 2009). Painpersistence behavior was negatively correlated with the CAR, and patients engaging in more of this behavior exhibited a lower CAR than patients engaging in less of it.…”

“…Considering pain as a stressor and the general effects of coping strategies on HPA axis activity (Ursin and Eriksen 2004) raises the question of whether pain-related responses might also play a mediating role in the association between pain and adrenocortical activity. Former studies by our research group have produced preliminary support for this assumption (Sudhaus et al 2007(Sudhaus et al , 2009. Based on previous evidence (Hasenbring et al 1994;Vlaeyen and Linton 2000;Edwards et al 2007), we focused on two response patterns that are known risk factors for the development of chronic low back pain of nonspecific origin and after lumbar disc surgery and are constitutive components of the avoidance-endurance model (Hasenbring and Verbunt 2010): the fear-avoidance-related and endurance-related response patterns (FAR and ER patterns).…”

“…Recent research in patients with non-specific low back pain provides preliminary evidence for differential effects of the ER and FAR patterns on individual stress levels in the short term. Overall, fear-avoidance responses, such as catastrophizing, helplessness/hopelessness and avoidance of activities, were associated with an increase in the level of pain-induced stress (Sudhaus et al 2009). In contrast, behavioral endurance despite pain seems to lower stress arousal in the short term (Sudhaus et al 2009).…”

“…Overall, fear-avoidance responses, such as catastrophizing, helplessness/hopelessness and avoidance of activities, were associated with an increase in the level of pain-induced stress (Sudhaus et al 2009). In contrast, behavioral endurance despite pain seems to lower stress arousal in the short term (Sudhaus et al 2009). To the best of our knowledge, no study has investigated the relationship between ER/FAR and HPA axis activity in patients after lumbar disc surgery.…”

Hypothalamus-Pituitary-Adrenal Axis Hypersuppression Is Associated with Gastrointestinal Symptoms in Major Depression

“…5,7,8 The present study focuses on the HPA-axis, which plays a central role in the neuroendocrine response to stress with cortisol being it's main effector constituent, since both IBS and depression have been reported to exhibit HPAaxis dysregulation and that stress-dysregulation has been suggested as one important etiologic factor in both conditions. [9][10][11][12][13][14][15][16][17][18] While stress has traditionally been associated with increased cortisol levels and HPA-axis hyperactivity, there is a growing body of literature describing lowered cortisol levels and hypoactivity of the HPA-axis in a number of stress related disorders [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] ; eg, posttraumatic stress disorder (PTSD), 30,31 chronic fatigue syndrome, [22][23][24] burnout, 25,26 as well as in fibromyalgia and chronic somatic pain conditions of unknown or uncertain etiology. 28,29,[32][33][34] Dysfunction of the HPA-axis, including hypoactivity, has also been reported in IBS.…”