title: Salivary cortisol and psychological mechanisms in patients with acute versus chronic low back pain.
abstract: This study was designed to explore whether the basal adrenocortical activity is related with pain-related coping, nonverbal pain behavior, depressive mood, and fatigue in patients with acute and chronic nonspecific low back pain. 19 patients with acute low back pain (ALBP) and 24 with chronic low back pain (CLBP) participated in the study. The adrenocortical activity was assessed through the cortisol awakening response. All participants provided five saliva samples (0, 15, 30, 45, and 60min after waking) on two consecutive days off work. Pain-related coping [fear-avoidance coping (FAC) and endurance coping (EC)], nonverbal pain behavior (NPB), depressive mood, and fatigue were assessed through questionnaires. Among ALPB patients, EC was negatively associated with the cortisol release, whereas fatigue was positively associated with it. Among CLBP patients, FAC, NPB, depressive mood, and fatigue were negatively associated with the cortisol awakening response, whereas EC tended to be positively associated with it. The results indicate that pain-related coping strategies which are expected to be successful appear to lower the adrenocortical activity among ALBP patients, whereas affective distress may enhance the level of cortisol in this group. Among CLBP patients, long-term maladaptive coping strategies might contribute to hypocortisolism.
authors.affiliation: Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Universitätsstr. 150, 44780 Bochum, Germany. sigrid.sudhaus@rub.de
authors.forename: Sigrid
authors.initials: S
authors.lastname: Sudhaus
authors.forename: Britta
authors.initials: B
authors.lastname: Fricke
authors.forename: Axel
authors.initials: A
authors.lastname: Stachon
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneider
authors.forename: Harald
authors.initials: H
authors.lastname: Klein
authors.forename: Monika
authors.initials: M
authors.lastname: von Düring
authors.forename: Monika
authors.initials: M
authors.lastname: Hasenbring
mesh_terms: D000208:Acute Disease; D000223:Adaptation, Psychological / Q000502:physiology*; D000302:Adrenal Cortex / Q000378:metabolism; D000328:Adult; D002908:Chronic Disease; D017281:Cost of Illness; D003863:Depression / Q000150:complications / Q000378:metabolism / Q000523:psychology; D005221:Fatigue / Q000150:complications / Q000378:metabolism / Q000523:psychology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D055809:Illness Behavior / Q000502:physiology*; D017116:Low Back Pain / Q000150:complications / Q000378:metabolism* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000378:metabolism* / Q000523:psychology; D010147:Pain Measurement; D012463:Saliva / Q000378:metabolism
chemical_list: D006854:Hydrocortisone