title: Autonomic activation and pain in response to low-grade mental stress in fibromyalgia and shoulder/neck pain patients.
abstract: OBJECTIVE
  Psychosocial stress is a risk factor for musculoskeletal pain, but how stress affects musculoskeletal pain is poorly understood. We wanted to examine the relationship between low-grade autonomic activation and stress-related pain in patients with fibromyalgia and localised chronic shoulder/neck pain.
  
  
  METHODS
  Twenty-three female patients with fibromyalgia, 29 female patients with chronic shoulder-neck pain, and 35 healthy women performed a stressful task lasting 60min. With a blinded study design, we recorded continuous blood pressure, heart rate, finger skin blood flow and respiration frequency before (10min), during (60min) and after (30min) the stressful task. The physiological responses were compared with subjective reports of pain.
  
  
  RESULTS
  The increase in diastolic blood pressure and heart rate in response to the stressful task were smaller in fibromyalgia patients compared with the healthy controls. Furthermore, fibromyalgia patients had reduced finger skin blood flow at the end of the stressful task compared to healthy controls. We also found an inverse relationship between the heart rate response and development and recovery of the stress-related pain in fibromyalgia patients.
  
  
  CONCLUSIONS
  We found abnormal cardiovascular responses to a 60min long stressful task in fibromyalgia patients. Furthermore, we found a negative association between the heart rate response and the pain which developed during the stressful task in the fibromyalgia group, possibly a result of reduced stress-induced analgesia for fibromyalgia patients.
authors.affiliation: Norwegian University of Science and Technology, Department of Neurosciences, N-7489, Trondheim, Norway. kristian.b.nilsen@ntnu.no
authors.forename: Kristian Bernhard
authors.initials: KB
authors.lastname: Nilsen
authors.forename: Trond
authors.initials: T
authors.lastname: Sand
authors.forename: Rolf Harald
authors.initials: RH
authors.lastname: Westgaard
authors.forename: Lars Jacob
authors.initials: LJ
authors.lastname: Stovner
authors.forename: Linda R
authors.initials: LR
authors.lastname: White
authors.forename: Rune
authors.initials: R
authors.lastname: Bang Leistad
authors.forename: Grethe
authors.initials: G
authors.lastname: Helde
authors.forename: Magne
authors.initials: M
authors.lastname: Rø
mesh_terms: D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology* / Q000523:psychology; D001794:Blood Pressure; D002908:Chronic Disease; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology* / Q000523:psychology; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D019547:Neck Pain / Q000503:physiopathology* / Q000523:psychology; D012039:Regional Blood Flow; D015656:Respiratory Mechanics; D020069:Shoulder Pain / Q000503:physiopathology* / Q000523:psychology; D012867:Skin / Q000098:blood supply; D013315:Stress, Psychological / Q000503:physiopathology*