Open AccessEffects of Stress and Relaxation on Central Pain Modulation in Chronic Whiplash and Fibromyalgia Patients Compared to Healthy Controls
Author(s) -
Mira Meeus Prof.
Publication year - 2016
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.19.119
Subject(s) - fibromyalgia , medicine , whiplash , chronic pain , relaxation (psychology) , physical therapy , cognition , crossover study , relaxation therapy , randomized controlled trial , anesthesia , poison control , psychiatry , placebo , alternative medicine , environmental health , pathology
Background: Compelling evidence has demonstrated that impaired central pain modulationcontributes to persistent pain in patients with chronic whiplash associated disorders (WAD) andfibromyalgia (FM). However, there is limited research concerning the influence of stress andrelaxation on central pain modulation in patients with chronic WAD and FM.Objectives: The present study aims to investigate the effects of acute cognitive stress andrelaxation on central pain modulation in chronic WAD and FM patients compared to healthyindividuals.Study Design: A randomized crossover design was employed.Setting: The present study took place at the University of Brussels, the University HospitalBrussels, and the University of Antwerp.Methods: Fifty-nine participants (16 chronic WAD patients, 21 FM, 22 pain-free controls)were enrolled and subjected to various pain measurements. Temporal summation (TS) of painand conditioned pain modulation (CPM) were evaluated. Subsequently, participants wererandomly allocated to either a group that received progressive relaxation therapy or a group thatperformed a battery of cognitive tests (= cognitive stressor). Afterwards, all pain measurementswere repeated. One week later participant groups were switched.Results: A significant difference was found between the groups in the change in TS in responseto relaxation (P = 0.008) and cognitive stress (P = 0.003). TS decreased in response to relaxationand cognitive stress in chronic WAD patients and controls. In contrast, TS increased after bothinterventions in FM patients. CPM efficacy decreased in all 3 groups in response to relaxation (P= 0.002) and cognitive stress (P = 0.001).Limitations: The obtained results only apply for a single session of muscle relaxation therapyand cognitive stress, whereby no conclusions can be made for effects on pain perception andmodulation of chronic cognitive stress and long-term relaxation therapies.Conclusions: A single relaxation session as well as cognitive stress may have negative acuteeffects on pain modulation in patients with FM, while cognitive stress and relaxation did notworsen bottom-up sensitization in chronic WAD patients and healthy persons. However,endogenous pain inhibition, assessed using a CPM paradigm, worsened in chronic WAD andFM patients, as well as in healthy people following both interventions.Key words: Chronic pain, central sensitization, endogenous pain inhibition, temporalsummation of pain, cognitive stressor, relaxation, fibromyalgia, whiplash-associated disorders