Advertisement

Applied Psychophysiology and Biofeedback

, Volume 41, Issue 1, pp 9–16 | Cite as

Cortisol, Health, and Coping in Patients with Nonspecific Low Back Pain

  • Vigdis SveinsdottirEmail author
  • Hege R. Eriksen
  • Holger Ursin
  • Åse M. Hansen
  • Anette Harris
Article

Summary

Subjective health complaints (SHC), including nonspecific low back pain (LBP) as the most common single complaint, are the main reasons for long-term sick leave in many western countries. These complaints are often attributed to “stress”. Cortisol has frequently been considered a biomarker reflecting sustained physiological HPA-axis activity, and is characterized by a high cortisol awakening response (CAR) and low evening values. The aim of the study was to investigate whether LBP patients had a normal characteristic cortisol profile, and whether possible deviations were related to coping and health. 305 patients on long-term sick leave for LBP participated in the study, and saliva cortisol profiles were compared to a reference population consisting of Danish workers. Cortisol was measured upon awakening, after 30 min, and in the evening. Additionally, patients answered questionnaires about SHC, fatigue, pain, coping, and social support. The patients showed a seemingly normal cortisol profile. However, CAR was larger among patients compared to the reference population. Patients with low cortisol reactivity had more SHC, pain, and fatigue, and those with higher evening cortisol reported higher scores on coping. The results are discussed in terms of theory, practical considerations, and possible mechanisms for the association between cortisol, health, and coping.

Keywords

Cortisol Stress Subjective health complaints Pain Fatigue Low back pain 

References

  1. Bhagwagar, Z., Hafizi, S., & Cowen, P. J. (2005). Increased salivary cortisol after waking in depression. Psychopharmacology (Berl), 182(1), 54–57.CrossRefGoogle Scholar
  2. Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 60(2), 113–124.CrossRefPubMedGoogle Scholar
  3. Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., & Wallace, E. P. (1993). Development of a fatigue scale. Journal of Psychosomatic Research, 37(2), 147–153.CrossRefPubMedGoogle Scholar
  4. Dahlgren, A., Kecklund, G., Theorell, T., & Akerstedt, T. (2009). Day-to-day variation in saliva cortisol-relation with sleep, stress and self-rated health. Biological Psychology, 82(2), 149–155. doi: 10.1016/j.biopsycho.2009.07.001.CrossRefPubMedGoogle Scholar
  5. Eriksen, H. R., Ihlebaek, C., & Ursin, H. (1999). A scoring system for subjective health complaints (SHC). Scandinavian Journal of Public Health, 27(1), 63–72.CrossRefPubMedGoogle Scholar
  6. Eriksen, H. R., Olff, M., & Ursin, H. (1997). The CODE: A revised battery for coping and defense and its relations to subjective health. Scandinavian Journal of Psychology, 38(3), 175–182.CrossRefPubMedGoogle Scholar
  7. Eriksen, H. R., & Ursin, H. (2004). Subjective health complaints, sensitization, and sustained cognitive activation (stress). Journal of Psychosomatic Research, 56, 445–448.CrossRefPubMedGoogle Scholar
  8. Fabian, L., McGuire, L., Page, G., Goodin, B., Edwards, R., & Haythornthwaite, J. (2009). The association of the cortisol awakening response with experimental pain ratings. Psychoneuroendocrinology, 34(8), 1247–1251.CrossRefPubMedGoogle Scholar
  9. Fisher, E. B., Bickle, C., Harber, K., Hughes, C. R., Jeffe, D. B., Kahl, L., et al. (1997). Benefits of directive and nondirective support are moderated by severity of circumstances. Paper presented at the Annual Meeting of Society of Behavioral Medicine, San Francisco, CA.Google Scholar
  10. Fries, E., Dettenborn, L., & Kirschbaum, C. (2009). The cortisol awakening response (CAR): Facts and future directions. International Journal of Psychophysiology, 72(1), 67–73.CrossRefPubMedGoogle Scholar
  11. Fries, E., Hesse, J., Hellhammer, J., & Hellhammer, D. H. (2005). A new view on hypocortisolism. Psychoneuroendocrinology, 30(10), 1010–1016.CrossRefPubMedGoogle Scholar
  12. Hagen, E. M., Svensen, E., Eriksen, H. R., Ihlebaek, C. M., & Ursin, H. (2006). Comorbid subjective health complaints in low back pain. Spine, 31(13), 1491–1495.CrossRefPubMedGoogle Scholar
  13. Hansen, A. M., Blangsted, A. K., Hansen, E. A., Sogaard, K., & Sjogaard, G. (2010). Physical activity, job demand-control, perceived stress-energy, and salivary cortisol in white-collar workers. International Archives of Occupational and Environmental Health, 83(2), 143–153.CrossRefPubMedGoogle Scholar
  14. Hansen, A. M., Garde, A. H., Christensen, J. M., Eller, N. H., & Netterstrom, B. (2003). Evaluation of a radioimmunoassay and establishment of a reference interval for salivary cortisol in healthy subjects in Denmark. Scandinavian Journal of Clinical and Laboratory Investigation, 63(4), 303–310.CrossRefPubMedGoogle Scholar
  15. Hansen, A. M., Hogh, A., & Persson, R. (2011). Frequency of bullying at work, physiological response, and mental health. Journal of Psychosomatic Research, 70(1), 19–27.CrossRefPubMedGoogle Scholar
  16. Harris, A., Endresen Reme, S., Tangen, T., Hansen, A. M., Helene Garde, A., & Eriksen, H. R. (2015). Diurnal cortisol rhythm: Associated with anxiety and depression, or just an indication of lack of energy? Psychiatry Research, 228(2), 209–215. doi: 10.1016/j.psychres.2015.04.006.CrossRefPubMedGoogle Scholar
  17. Harris, A., Ursin, H., Murison, R., & Eriksen, H. R. (2007). Coffee, stress and cortisol in nursing staff. Psychoneuroendocrinology, 32(4), 322–330.CrossRefPubMedGoogle Scholar
  18. Heim, C., Ehlert, U., & Hellhammer, D. H. (2000). The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology, 25(1), 1–35.CrossRefPubMedGoogle Scholar
  19. Hellman, L., Nakada, F., Curti, J., Weitzman, E. D., Kream, J., Roffwarg, H., & Gallagher, T. F. (1970). Cortisol is secreted episodically by normal man. The Journal of Clinical Endocrinology & Metabolism, 30(4), 411–422.CrossRefGoogle Scholar
  20. Henschke, N., Maher, C. G., Refshauge, K. M., Herbert, R. D., Cumming, R. G., Bleasel, J., & McAuley, J. H. (2009). Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis and Rheumatism, 60(10), 3072–3080.CrossRefPubMedGoogle Scholar
  21. Indregard, A. M., Ihlebaek, C. M., & Eriksen, H. R. (2012). Modern health worries, subjective health complaints, health care utilization, and sick leave in the Norwegian working population. International Journal of Behavioral Medicine, 20(3), 371–377.CrossRefGoogle Scholar
  22. Jacobsen, H. B., Bjorngaard, J. H., Hara, K. W., Borchgrevink, P. C., Woodhouse, A., Landro, N. I., & Stiles, T. C. (2014). The role of stress in absenteeism: Cortisol responsiveness among patients on long-term sick leave. PLoS ONE, 9(5), e96048. doi: 10.1371/journal.pone.0096048.PubMedCentralCrossRefPubMedGoogle Scholar
  23. Johansson, A.-C., Gunnarsson, L.-G., Linton, S. J., Bergkvist, L., Stridsberg, M., Nilsson, O., & Cornefjord, M. (2008). Pain, disability and coping reflected in the diurnal cortisol variability in patients scheduled for lumbar disc surgery. European Journal of Pain, 12(5), 633–640.CrossRefPubMedGoogle Scholar
  24. Kirschbaum, C., & Hellhammer, D. H. (2000). Salivary cortisol. In G. Fink (Ed.), Encyclopedia of stress (pp. 379–383). California: Academic Press.Google Scholar
  25. Kleinböhl, D., Hölzl, R., Möltner, A., Rommel, C., Weber, C., & Osswald, P. M. (1999). Psychophysical measures of sensitization to tonic heat discriminate chronic pain patients. Pain, 81(1–2), 35–43.CrossRefPubMedGoogle Scholar
  26. Kristenson, M., Eriksen, H., Sluiter, J., Starke, D., & Ursin, H. (2004). Psychobiological mechanisms of socioeconomic differences in health. Social Science and Medicine, 58(8), 1511–1522.CrossRefPubMedGoogle Scholar
  27. Lærum, E., Brox, J. I., Storheim, K., Espeland, A., Haldorsen, E., Munch-Ellingsen, J., & Werner, E. L. (2007). Norwegian clinical guidelines: Low back pain with and without radiculopathy. Oslo: FORMI & The Norwegian Directorate of Health.Google Scholar
  28. Levine, A., Zagoory-Sharon, O., Feldman, R., Lewis, J. G., & Weller, A. (2007). Measuring cortisol in human psychobiological studies. Physiology & Behavior, 90(1), 43–53.CrossRefGoogle Scholar
  29. Loge, J. H., Ekeberg, Ø., & Kaasa, S. (1998). Fatigue in the general Norwegian population: Normative data and associations. Journal of Psychosomatic Research, 45(1), 53–65. doi: 10.1016/S0022-3999(97)00291-2.CrossRefPubMedGoogle Scholar
  30. McBeth, J., Silman, A. J., Gupta, A., Chiu, Y. H., Ray, D., Morriss, R., & Macfarlane, G. J. (2007). Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: Findings of a population-based prospective cohort study. Arthritis and Rheumatism, 56(1), 360–371.CrossRefPubMedGoogle Scholar
  31. Miller, G. E., Chen, E., & Zhou, E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological Bulletin, 133(1), 25–45.CrossRefPubMedGoogle Scholar
  32. Øyeflaten, I., Gabriele, J. M., Fisher, E. B., & Eriksen, H. R. (2010). Social support and subjective health complaints in occupational rehabilitation. International Journal of Therapy and Rehabilitation, 17(8), 424–435.CrossRefGoogle Scholar
  33. Persson, R., Garde, A. H., Hansen, Å. M., Österberg, K., Larsson, B., Ørbæk, P., & Karlson, B. (2008). Seasonal variation in human salivary cortisol concentration. Chronobiology International, 25(6), 923–937. doi: 10.1080/07420520802553648.CrossRefPubMedGoogle Scholar
  34. Reme, S. E., Tangen, T., Moe, T., & Eriksen, H. R. (2011a). Prevalence of psychiatric disorders in sick listed chronic low back pain patients. European Journal of Pain, 15(10), 1075–1080.CrossRefPubMedGoogle Scholar
  35. Reme, S. E., Tveito, T. H., Chalder, T., Bjørkkjær, T., Indahl, A., Brox, J. I., & Eriksen, H. R. (2011b). Protocol for the cognitive interventions and nutritional supplements (CINS) trial: A randomized controlled multicenter trial of a brief intervention (BI) versus a BI plus cognitive behavioral treatment (CBT) versus nutritional supplements for patients with long-lasting muscle and back pain. BMC Musculoskelet Disorders, 12, 152.CrossRefGoogle Scholar
  36. Riva, R., Mork, P. J., Westgaard, R. H., Ro, M., & Lundberg, U. (2010). Fibromyalgia syndrome is associated with hypocortisolism. International Journal of Behavioral Medicine, 17(3), 223–233.CrossRefPubMedGoogle Scholar
  37. Roberts, A. D., Wessely, S., Chalder, T., Papadopoulos, A., & Cleare, A. J. (2004). Salivary cortisol response to awakening in chronic fatigue syndrome. British Journal of Psychiatry, 184, 136–141.CrossRefPubMedGoogle Scholar
  38. Roelen, C. A., Koopmans, P. C., & Groothoff, J. W. (2010). Subjective health complaints in relation to sickness absence. Work, 37(1), 15–21.PubMedGoogle Scholar
  39. Schafer, I., Kaduszkiewicz, H., Wagner, H. O., Schon, G., Scherer, M., & van den Bussche, H. (2014). Reducing complexity: A visualisation of multimorbidity by combining disease clusters and triads. BMC Public Health, 14, 1285. doi: 10.1186/1471-2458-14-1285.PubMedCentralCrossRefPubMedGoogle Scholar
  40. Schreurs, P. J. G., Van De Willige, G., Brosschot, J. F., Tellegen, B., & Graus, G. M. H. (1993). De Utrechtse Coping Lijst: UCL. Lisse: Swets & Zeitlinger.Google Scholar
  41. Sjögren, E., Leanderson, P., & Kristenson, M. (2006). Diurnal saliva cortisol levels and relations to psychosocial factors in a population sample of middle-aged Swedish men and women. International Journal of Behavioral Medicine, 13(3), 193–200.CrossRefPubMedGoogle Scholar
  42. Smyth, J., Ockenfels, M. C., Porter, L., Kirschbaum, C., Hellhammer, D. H., & Stone, A. A. (1998). Stressors and mood measured on a momentary basis are associated with salivary cortisol secretion. Psychoneuroendocrinology, 23(4), 353–370.CrossRefPubMedGoogle Scholar
  43. Staud, R., Vierck, C. J., Cannon, R. L., Mauderli, A. P., & Price, D. D. (2001). Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain, 91(1–2), 165–175.CrossRefPubMedGoogle Scholar
  44. Tak, L. M., Cleare, A. J., Ormel, J., Manoharan, A., Kok, I. C., Wessely, S., & Rosmalen, J. G. (2011). Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders. Biological Psychology, 87(2), 183–194.CrossRefPubMedGoogle Scholar
  45. Ursin, H. (1997). Sensitization, somatization, and subjective health complaints. International Journal of Behavioral Medicine, 4(2), 105–116. doi: 10.1207/s15327558ijbm0402_1.CrossRefPubMedGoogle Scholar
  46. Ursin, H., & Eriksen, H. R. (2004). The cognitive activation theory of stress. Psychoneuroendocrinology, 29, 567–592.CrossRefPubMedGoogle Scholar
  47. Vachon-Presseau, E., Roy, M., Martel, M. O., Caron, E., Marin, M. F., Chen, J., & Rainville, P. (2013). The stress model of chronic pain: Evidence from basal cortisol and hippocampal structure and function in humans. Brain, 136(Pt 3), 815–827.CrossRefPubMedGoogle Scholar
  48. Verne, G., & Price, D. (2002). Irritable bowel syndrome as a common precipitant of central sensitization. Current Rheumatology Reports, 4(4), 322–328. doi: 10.1007/s11926-002-0041-x.CrossRefPubMedGoogle Scholar
  49. Vreeburg, S. A., Hoogendijk, W. J., Derijk, R. H., van Dyck, R., Smit, J. H., Zitman, F. G., & Penninx, B. W. (2013). Salivary cortisol levels and the 2-year course of depressive and anxiety disorders. Psychoneuroendocrinology, 10(12), 00430–00431.Google Scholar
  50. Vreeburg, S. A., Hoogendijk, W. J., van Pelt, J., Derijk, R. H., Verhagen, J. C., van Dyck, R., & Penninx, B. W. (2009). Major depressive disorder and hypothalamic-pituitary-adrenal axis activity: Results from a large cohort study. Archives of General Psychiatry, 66(6), 617–626.CrossRefPubMedGoogle Scholar
  51. Wilhelm, I., Born, J., Kudielka, B. M., Schlotz, W., & Wust, S. (2007). Is the cortisol awakening rise a response to awakening? Psychoneuroendocrinology, 32(4), 358–366.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Vigdis Sveinsdottir
    • 1
    Email author
  • Hege R. Eriksen
    • 1
    • 2
  • Holger Ursin
    • 1
  • Åse M. Hansen
    • 3
    • 4
  • Anette Harris
    • 1
    • 2
  1. 1.Uni Research HealthUni ResearchBergenNorway
  2. 2.Department of Health Promotion and DevelopmentUniversity of BergenBergenNorway
  3. 3.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
  4. 4.National Research Centre for the Working EnvironmentCopenhagenDenmark

Personalised recommendations