Article

Pain is a primary symptom driving patients to seek physical therapy, and its
attenuation commonly defines a successful outcome. A large body of evidence is
dedicated to elucidating the relationship between chronic stress and pain;
however, stress is rarely addressed in pain rehabilitation. A physiologic stress
response may be evoked by fear or perceived threat to safety, status, or
well-being and elicits the secretion of sympathetic catecholamines (epinephrine
and norepinepherine) and neuroendocrine hormones (cortisol) to promote survival
and motivate success. Cortisol is a potent anti-inflammatory that functions to
mobilize glucose reserves for energy and modulate inflammation. Cortisol also may
facilitate the consolidation of fear-based memories for future survival and
avoidance of danger. Although short-term stress may be adaptive, maladaptive
responses (eg, magnification, rumination, helplessness) to pain or
non-pain-related stressors may intensify cortisol secretion and condition a
sensitized physiologic stress response that is readily recruited. Ultimately, a
prolonged or exaggerated stress response may perpetuate cortisol dysfunction,
widespread inflammation, and pain. Stress may be unavoidable in life, and
challenges are inherent to success; however, humans have the capability to modify
what they perceive as stressful and how they respond to it. Exaggerated
psychological responses (eg, catastrophizing) following maladaptive cognitive
appraisals of potential stressors as threatening may exacerbate cortisol
secretion and facilitate the consolidation of fear-based memories of pain or
non-pain-related stressors; however, coping, cognitive reappraisal, or
confrontation of stressors may minimize cortisol secretion and prevent chronic,
recurrent pain. Given the parallel mechanisms underlying the physiologic effects
of a maladaptive response to pain and non-pain-related stressors, physical
therapists should consider screening for non-pain-related stress to facilitate
treatment, prevent chronic disability, and improve quality of life.
CI - (c) 2014 American Physical Therapy Association.

Langue : ANGLAIS