Pain Catastrophizing and Salivary Cortisol Responses to Laboratory Pain Testing in Temporomandibular Disorder and Healthy Participants

• Published in: The journal of pain Vol. 11; no. 2; pp. 186 - 194
• Main Authors: Quartana, Phillip J, Buenaver, Luis F, Edwards, Robert R, Klick, Brendan, Haythornthwaite, Jennifer A, Smith, Michael T
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2010
• Subjects: Adult; Anesthesia & Perioperative Care; Association; Chi-Square Distribution; Female; HPA; Humans; Hydrocortisone - metabolism; Male; Pain - etiology; Pain - psychology; Pain catastrophizing; Pain Measurement - methods; Pain Medicine; pain threshold; Pain Threshold - physiology; Physical Stimulation - adverse effects; Polysomnography - methods; pressure pain; Psychophysics - methods; Saliva - chemistry; Surveys and Questionnaires; temporomandibular disorders; Temporomandibular Joint Disorders - complications; Temporomandibular Joint Disorders - metabolism; Temporomandibular Joint Disorders - psychology; thermal pain; Young Adult; HPA; Pain catastrophizing; pressure pain; thermal pain; pain threshold; temporomandibular disorders
• ISSN: 1526-5900; 1528-8447
• DOI: 10.1016/j.jpain.2009.07.008

Abstract Pain catastrophizing is an important variable in the context of acute and chronic pain. The neurophysiological correlates of pain catastrophizing, however, have not been rigorously evaluated. We examined the relationship between trait-pain catastrophizing and morning salivary cortisol levels before and following a 45-minute laboratory pain-testing session in healthy, pain-free (n = 22), and temporomandibular disorder (TMD) participants (n = 39). We also examined whether TMD patients evidenced generalized hyperalgesia and hypercortisolism. Pain catastrophizing was associated with a flattened morning salivary cortisol profile in the context of pain testing, irrespective of pain status. Cortisol profiles did not differ between healthy and TMD participants. TMD was associated with mechanical hyperalgesia only at the masseter. These data are the first to show an association between pain catastrophizing and elevated salivary cortisol profiles in the context of standardized experimental pain testing. These findings in both healthy individuals and those with chronic orofacial pain suggest that aberrant adrenocortical responses to pain may serve as a neurophysiologic pathway by which pain catastrophizing enhances vulnerability for development of chronic pain and maintains and/or exaggerates existing pain and associated morbidity. Perspective Neurophysiological mechanisms by which pain catastrophizing is related to acute and chronic pain recently have come under empirical study. Understanding of these mechanisms has the unique potential to shed light on key central-nervous-system factors that mediate catastrophizing-pain relations and therapeutic benefits associated with changes in catastrophizing and related cognitive processes.