Associations between fear-avoidance and endurance responses to pain and salivary cortisol in the context of experimental pain induction

Recent clinical studies in patients with lower back pain indicate that maladaptive fear-avoidance- and endurance-related pain responses (FAR and ER) have an influence on pain-induced physiological stress levels. The aim of the present study was to follow-up these results under well-controlled laboratory conditions. For this purpose, 30 healthy adults were asked to indicate their usual responses to pain, and were then confronted with an experimental pain stimulus (cold pressor test). Cortisol served as a measure of physiological stress. The results reveal positive associations between cortisol and FAR patterns, and negative associations between cortisol and behavioral ER. Conceivably, FAR contribute to long-lasting elevated stress levels in patients with stress-related musculoskeletal pain. In contrast, short-term, stress-lowering effects of ER might even be considered an advantage in coping with pain.