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Dissertation zugänglich unter
Effects of Stress Mechanisms on Pain Processing
Effekte von Stressmechanismen auf die Schmerzverarbeitung
Kühl, Linn Kristina
||(2010) einzelne Kapitel sind veröffentlicht in den Zeitschriften Pain, European Journal of Pain, Psychosomatic Medicine und Neurobiology of Learning and Memory
||Stress , Schmerz , Lernen , Physiologische Psychologie
|Freie Schlagwörter (Deutsch):
|Freie Schlagwörter (Englisch):
||stress, pain, cortisol, quantitative sensory testing, eyeblink conditioning
||Schächinger, Hartmut, Prof. Dr. med.
|Tag der mündlichen Prüfung:
|Kurzfassung auf Englisch:
||Stress and pain are common experiences in human lives. Both, the stress and the pain system have adaptive functions and try to protect the organism in case of harm and danger. However, stress and pain are two of the most challenging problems for the society and the health system. Chronic stress, as often seen in modern societies, has much impact on health and can lead to chronic stress disorders. These disorders also include a number of chronic pain syndromes. However, pain can also be regarded as a stressor itself, especially when we consider how much patients suffer from long-lasting pain and the impact of pain on life quality. In this way, the effects of stress on pain can be fostered. For the generation and manifestation of chronic pain symptoms also learning processes such as classical conditioning play an important role. Processes of classical conditioning can also be influenced by stress. These facts illustrate the complex and various interactions between the pain and the stress systems. Both systems communicate permanently with each other and help to protect the organism and to keep a homeostatic state. They have various ways of communication, for example mechanisms related to endogenous opioids, immune parameters, glucocorticoids and baroreflexes. But an overactivation of the systems, for example caused by ongoing stress, can lead to severe health problems. Therefore, it is of great importance to understand these interactions and their underlying mechanisms.
The present work deals with the relationship of stress and pain. A special focus is put on stress related hypocortisolism and pain processing, stress induced hypoalgesia via baroreceptor related mechanisms and stress related cortisol effects on aversive conditioning (as a model of pain learning). This work is a contribution to the wide field of research that tries to understand the complex interactions of stress and pain. To demonstrate the variety, the selected studies highlight different aspects of these interactions. In the first chapter I will give a short introduction on the pain and the stress systems and their ways of interaction. Furthermore, I will give a short summary of the studies presented in Chapter II to V and their background. The results and their meaning for future research will be discussed in the last part of the first chapter.
Chronic pain syndromes have been associated with chronic stress and alterations of the HPA axis resulting in chronic hypocortisolism. But if these alterations may play a causal role in the pathophysiology of chronic pain remains unclear. Thus, the study described in Chapter II investigated the effects of pharmacological induced hypocortisolism on pain perception.
Both, the stress and the pain system are related to the cardiovascular system. Increase of blood pressure is part of the stress reaction and leads to reduced pain perception. Therefore, it is important for the usage of pain tests to keep in mind potential interferences from activation of the cardiovascular system, especially when pain inhibitory processes are investigated. For this reason we compared two commonly and interchangeably used pain tests with regard to the triggered autonomic reactions. This study is described in chapter III.
Chapter IV and V deal with the role of learning processes in pain and related influences of stress. Processes of classical conditioning play an important role for symptom generation and manifestation. In both studies aversive eyeblink conditioning was used as a model for pain learning. In the study described in Chapter IV we compared classical eyeblink conditioning in healthy volunteers to patients suffering from fibromyalgia, a chronic pain disorder. Also, differences of the HPA axis, as part of the stress system, were taken in account. The study of Chapter V investigated effects of the very first stress reaction, particularly rapid non-genomic cortisol effects. Healthy volunteers received an intravenous cortisol administration immediately before the eyeblink conditioning. Rapid effects have only been demonstrated on a cellular level and on animal behavior so far.
In general, the studies presented in this work may give an impression of the broad variety of possible interactions between the pain and the stress system. Furthermore, they contribute to our knowledge about theses interactions. However, more research is needed to complete the picture.
|Kurzfassung auf Deutsch:
||Stress moduliert Schmerz. Akuter Stress wirkt schmerzhemmend. Dauerhafter Stress wird jedoch eher mit chronischen Schmerzzuständen in Verbindung gebracht. Diese Zusammenhänge werden u.a. durch physiologische Faktoren vermittelt, z.B. körpereigene Opioide, Baroreflexmechanismen und das Stresshormon Cortisol. Gerade bei der Manifestation chronischer Schmerzen spielen außerdem psychologische Faktoren und assoziative Lernprozesse, wie die Klassische Konditionierung, eine wichtige Rolle, die wiederum durch Stress bzw. durch das Stresshormon Cortisol beeinflusst werden. Im Rahmen dieser Dissertation wurden mehrere psychobiologische Humanexperimente durchgeführt, die der Erforschung der Interaktion von Stress und Schmerz dienen.