RESEARCH REPORT POSTER DISPLAY

PHYSIOLOGICAL STRESS MARKERS AND PAIN IN NECK, SHOULDER AND BACK IN HEALTHY MEDIA WORKERS. 12 MONTHS’ PROSPECTIVE FOLLOW UP. Schell E¹, Theorell T², Hasson D^3,4, Arnetz B^4,5, Saraste H¹; ¹Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden. ²Karolinska Institutet, National Institute for Psychosocial Factors and Health, and Center for Health Sciences, Stockholm, Sweden. ³Karolinska Institutet, CRU/Karolinska Universitetssjukhuset, Stockholm, Sweden. ⁴Uppsala Universitet, Department of Public Health and Caring Sciences, Uppsala, Sweden. ⁵Division of Occupational and Environmental Health, Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, USA

PURPOSE: Changes in physiological stress markers are shown in patients with chronic pain and stress. It is not shown if there are similar changes in a working population with mild or moderate musculoskeletal pain. The aims were to study: 1. Associations between self reported pain (VAS) in neck-shoulder-back on one hand and stress-related (catabolic), regenerative (anabolic) variables, cardiovascular/lifestyle factors and immune markers on the other hand. 2. Associations between changes in pain and stress marker values during 6 months. 3. Predicting physiological stress factors at month 0 for pain 12 months later. RELEVANCE: Pain and stress disorders are costly and are increasing. Identification of markers for early risk factors is of importance. PARTICIPANTS: The study group was 126 media-workers, 70 males (43 yrs) and 56 females (47 yrs) in stress and computer intensive occupations. The reference group was an equivalent staff group (n=123). All participants signed informed consent. METHODS: At months 0, 6 and 12 respectively, both groups answered a questionnaire on self rated pain (VAS), medicine intake and occupation. In the study group blood samples, BMI and blood pressure were documented at month 0, 6 and 12. An additional questionnaire was responded simultaneously. ANALYSIS: Both parametric and non-parametric analyses were performed, and not normal distributed values were logarithmised. Results from parametric analyses, adjusted for age and genders, are presented. Cross-sectional and longitudinal analysis were performed by one way Anova and prognostic value analyses with multiple forward step wise linear regression with respect to pain. RESULTS: The participation rate in the questionnaire was>97% in both groups, 100% in physiological stress marker assessments. The two groups were similar in pain rate at months 0, 6 and 12, in age, medicine intake and occupation. In both groups females had significantly higher pain levels. Pain, recorded within the same hour as blood tests were performed, significantly and indirectly correlated (p < 0.050) to the anabolic markers S-DHEAS and to P-Endothelin, and directly to S-Insulin and P-Fibrinogen. Gender separated analysis, revealed in males direct pain correlation to S-Insulin, Saliva cortisol 3, and indirect to P-Endothelin. BMI and P-Fibrinogen showed direct, and S-Testosterone indirect, correlation tendencies. In females direct correlation between pain and P-BNP was revealed. Decreasing pain level months 6-12 correlated significantly to changes in following anabolic and pain protecting stress markers (p = 0.016-.039): P-NPY, S-Albumin, S-GH and S-HDL, with positive mean differences and vice verse. Linear regression analyses, showed significant predicting values month 0 for pain 12 months later in lower S-DHEAS, S-albumin and higher B-HbA1c and P-fibrinogen. CONCLUSIONS: The present study shows that individuals in working life with a high level of regenerative/anabolic activity are less likely to have pain than other subjects, and that decreasing such activity is associated with increasing pain. Predicting values were found. Findings might have implications for preventing chronic pain in persons with early pain. IMPLICATIONS: Physiotherapists meet persons from working life with MSP and stress, in occupational health work and rehabilitation. The earlier risk factors can be identified, the more efficiently the prevention and treatment can be planned. KEYWORDS: Physiological stress markers, neck/back pain, stress. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: e.schell@telia.com

ETHICS COMMITTEE: Ethics Committee at Karolinska Institutet; Ethics Committee at Uppsala Universitet.