European Spine Journal

, Volume 17, Issue 3, pp 393–405 | Cite as

Stress biomarkers' associations to pain in the neck, shoulder and back in healthy media workers: 12-month prospective follow-up

  • Elisabet SchellEmail author
  • Tores Theorell
  • Dan Hasson
  • Bengt Arnetz
  • Helena Saraste
Original Article


Physiological and psychological mechanisms have been proposed to link stress and musculoskeletal pain (MSP), and a number of stress biomarkers in patients with chronic pain have shown to be associated with stress-related disorders as well as health and recovery. The aim was to study if similar results might be found in a working population, in stress and computer intensive occupations with mild/moderate pain in neck, shoulder and back. The questions were if there are: (1) associations between self rated neck, shoulder and back pain (VAS) on one hand and stress-related (catabolic), recovery related (anabolic) variables, cardiovascular/lifestyle factors and immune markers on the other hand. (2) associations between long term changes in pain and stress marker values (6 month period). (3) predictive values in stress biomarkers for pain (12 month period) A study group with 121 media workers, 67 males (average 45 years) and 53 females (average 43 years), at three news departments of a media company was recruited. Pain occurrence and pain level in neck, shoulder, upper and low back were self-rated at three times with a 6-month interval towards the last month. Stress biomarker sampling was performed, at the same intervals. An additional similar questionnaire with momentary ratings focusing on “at present” i.e. within the same hour as stress biomarker sampling was performed. There were no changes in medicine intake or computer working hours during the 12 month study period. The total pain level and prevalence of pain decreased between baseline and 12 months´ follow-up. The rate of participation was 95%. Cross-sectional analyses on differences in stress biomarkers in groups of “no pain” and “pain” showed less beneficial stress biomarker levels (P < 0.05) in the “pain” group after age and gender adjustments in: S-DHEA-S and P-endothelin, S-insulin and P-fibrinogen. Analyses of each gender separately, adjusted for age, revealed in males differences in S-insulin, saliva cortisol 3, and P-endothelin. Furthermore, tendencies were seen in BMI, P-fibrinogen, and S-testosterone. In the female “pain” group a less beneficial P-BNP level was found. Longitudinal analysis of changes in pain levels and stress biomarkers within an interval of 6 months showed beneficial changes in the following stress markers: P-NPY, S-albumin, S-growth hormone and S-HDL when pain decreased, and vice versa when pain increased. Linear regression analyses showed statistically significant predicting values at the initial test instance for pain 12 months later in lower S-DHEA-S and S-albumin and higher B-HbA1c and P-fibrinogen. In stepwise regression and after age and gender adjustments, the associations with S-DHEA-S remained statistically significant. The present study shows that individuals in working life with a high level of regenerative/anabolic activity have less pain than other subjects, and that decreased regenerative/anabolic activity is associated with increasing pain. The levels of NPY, albumin, GH and HDL increased when pain decreased and vice versa. Low DHEA-S predicted pain 12 months later. These findings might contribute to increased knowledge about strategies to prevent further progression of neck/shoulder/back pain in persons who are “not yet in chronic pain”.


Stress biomarkers Neck- shoulder- and back pain Work stress 



We thank the administration staff at the Swedish Broadcasting Company for Radio and Television for their collaboration. We also thank Bo Nilsson for contribution and assistance in the statistical analyses. No financial interests were involved.


  1. 1.
    Altman DG (1991) Practical statistics for medical research London. Chapman & Hall, LondonGoogle Scholar
  2. 2.
    Anderberg UM, Liu Z, Berglund L, Nyberg F (1999) Elevated plasma levels of neuropeptide Y in female fibromyalgia patients. Eur J Pain 3(1):19–30PubMedCrossRefGoogle Scholar
  3. 3.
    Antonijevic IA, Murck H, Frieboes RM, Barthelmes J, Steiger A (2000) Sexually dimorphic effects of GHRH on sleep-endocrine activity in patients with depression and normal controls—part I: the sleep eeg. Sleep Res Online 3(1):5–13PubMedGoogle Scholar
  4. 4.
    Arnetz BB, Wiholm C (1997) Technological stress: psychophysiological symptoms in modern offices. J Psychosom Res 43(1):35–42PubMedCrossRefGoogle Scholar
  5. 5.
    Bennett R (2004) Growth hormone in musculoskeletal pain states. Curr Rheumatol Rep 6(4):266–273PubMedCrossRefGoogle Scholar
  6. 6.
    Daniel WW (1978) Biostatistics: a foundation for analysis in the health sciences, 2nd edn. Wiley, New YorkGoogle Scholar
  7. 7.
    Estlander AM, Takala EP, Viikari-Juntura E (1998) Do psychological factors predict changes in musculoskeletal pain? A prospective, two-year follow-up study of a working population. J Occup Environ Med 40(5):445–453PubMedCrossRefGoogle Scholar
  8. 8.
    Evers Larsson U (2004) Influence of weight loss on pain, perceived disability and observed functional limitations in obese women. Int J Obes 28(2):269–277Google Scholar
  9. 9.
    Ganroth PO, Grubb A, Stenflo J (1997) Clinical chemistry (in Swedish: Klinisk Kemi). ISBN 91-4400490-7, Studentlitteratur.
  10. 10.
    Griep EN, Boersma JW, Lentjes EG, Prins AP, van der Korst JK, de Kloet ER (1998) Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain. J Rheumatol 25(7):1374–1381PubMedGoogle Scholar
  11. 11.
    Han TS, Schouten JS, Lean ME, Seidell JC (1997) The prevalence of low back pain and associations with body fatness, fat distribution and height. Int J Obes Relat Metab Disord 21(7):600–607PubMedCrossRefGoogle Scholar
  12. 12.
    Hasselhorn HM, Theorell T, Vingard E (2001) Musculoskeletal Intervention Center (MUSIC)-Norrtalje Study Group. Endocrine and immunologic parameters indicative of 6-month prognosis after the onset of low back pain or neck/shoulder pain. Spine 26(3):E24–E29PubMedCrossRefGoogle Scholar
  13. 13.
    Hasson D, Anderberg UM, Theorell T, Arnetz BB (2005) Psychophysiological effects of a web-based stress management system: A prospective, randomized controlled intervention study of IT and media workers. BMC Public Health. doi: 10.1186/1471-2458-5-78 5:78
  14. 14.
    Kaergaard A, Hansen AM, Rasmussen K, Andersen JH (2000) Associations between plasma testosterone and work related neck and shoulder disorders among female workers. Scand J Work Environ Health 26(4):292–298PubMedGoogle Scholar
  15. 15.
    Kaila-Kangas L, Leino-Arjas P, Riihimaki H, Luukkonen R, Kirjonen J (2003) Smoking and overweight as predictors of hospitalization for back disorders. Spine 28(16):1860–1868PubMedCrossRefGoogle Scholar
  16. 16.
    Klass M, Hord A, Wilcox M, Denson D, Csete M (2005) A role for endothelin in neuropathic pain after chronic constriction injury of the sciatic nerve. Anesth Analg 101(6):1757–1762PubMedCrossRefGoogle Scholar
  17. 17.
    Korhonen T, Ketola R, Toivonen R, Luukkonen R, Hakkanen M, Viikari-Juntura E, Estlander AM, Takala EP (2003) Work related and individual predictors for incident neck pain among office employees working with video display units. Occup Environ Med 60(7):475–482PubMedCrossRefGoogle Scholar
  18. 18.
    Kroboth PD, Salek FS, Pittenger AL, Fabian TJ, Frye RF (1999) DHEA and DHEA-S: a review. J Clin Pharmacol 39(4):327–348PubMedCrossRefGoogle Scholar
  19. 19.
    Leal-Cerro A, Povedano J, Astorga R, Gonzalez M, Silva H, Garcia-Pesquera F, Casanueva FF, Dieguez C (1999) The growth hormone (GH)-releasing hormone-GH-insulin-like growth factor-1 axis in patients with fibromyalgia syndrome. J Clin Endocrinol Metab 84(9):3378–3381PubMedCrossRefGoogle Scholar
  20. 20.
    Lundberg U (2002) Psychophysiology of work: stress, gender, endocrine response, and work-related upper extremity disorders. Am J Ind Med 41(5):383–392PubMedCrossRefGoogle Scholar
  21. 21.
    Lundberg U, Dohns IE, Melin B, Sandsjo L, Palmerud G, Kadefors R, Ekstrom M, Parr D (1999) Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers. J Occup Health Psychol 4(3):245–255PubMedCrossRefGoogle Scholar
  22. 22.
    Myrianthefs P, Karatza S, Venetsanou K, Grouzi E, Evagelopoulou P, Boutzouka E, Fildissis G, Spiliotopoulou I, Baltopoulos G (2003) Seasonal variation in whole blood system. Cytokine 24(6):286–292PubMedCrossRefGoogle Scholar
  23. 23.
    Nattero G, Mengozzi G, Inconis T, Paradisi L (1996) Nitric oxide, endothelin-1, and transcranial Doppler in migraine. Findings in interictal conditions and during migraine attack. Headache 36(5):307–311PubMedCrossRefGoogle Scholar
  24. 24.
    Sandlund A, Matha P (2006) Karolinska University Hospital Laboratory, years 2002–2003 Start 45656.aspx
  25. 25.
    Struthers AD, Davies J (2005) B-type natriuretic peptide: a simple new test to indentify coronary artery disease? QJM 98(10):765–769PubMedCrossRefGoogle Scholar
  26. 26.
    Sturmer T, Raum E, Buchner M, Gebhardt K, Schiltenwolf M, Richter W, Brenner H (2005) Pain and high sensitivity C reactive protein in patients with chronic low back pain and acute sciatic pain. Ann Rheum Dis 64(6):921–925PubMedCrossRefGoogle Scholar
  27. 27.
    Theorell T (1996) Possible mechanisms behind the relationship between demand-control-support model and disorders of the locomotor system. Taylor & Frances, London, pp 65–73Google Scholar
  28. 28.
    Toda Y, Segal N, Toda T, Morimoto T, Ogawa R (2000) Lean body mass and body fat distribution in participants with chronic low back pain. Arch Intern Med 27(21):3265–3269CrossRefGoogle Scholar
  29. 29.
    Tritilanunt T, Wajanavisit W (2001) The efficacy of an aerobic exercise and health education program for treatment of chronic low back pain. J Med Assoc Thai 84(Suppl 2):S528–S533PubMedGoogle Scholar
  30. 30.
    Wiholm C, Arnetz B (2007) Stress management and musculoskeletal disorders in knowledge workers: the possible mediating effects of stress hormones. Adv Physiother (accepted)Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Elisabet Schell
    • 1
    Email author
  • Tores Theorell
    • 2
  • Dan Hasson
    • 3
    • 4
  • Bengt Arnetz
    • 4
    • 5
  • Helena Saraste
    • 1
  1. 1.Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
  2. 2.Karolinska Institutet, National Institute for Psychosocial Factors and Health, and Center for Health SciencesStockholmSweden
  3. 3.Karolinska Institutet, CRU/Karolinska UniversitetssjukhusetStockholmSweden
  4. 4.Department of Public Health and Caring SciencesUppsala UniversitetUppsalaSweden
  5. 5.Division of Occupational and Environmental Health, Department of Family Medicine and Public Health SciencesWayne State UniversityDetroitUSA

Personalised recommendations