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. 2012 May;28(4):291-9.
doi: 10.1097/AJP.0b013e31822cf542.

Enhanced cortisol increase upon awakening is associated with greater pain ratings but not salivary cortisol or soluble tumor necrosis factor-α receptor II responses to acute pain

Burel R Goodin  1 , Noel B Quinn, Christopher D King, Gayle G Page, Jennifer A Haythornthwaite, Robert R Edwards, Laura M Stapleton, Lynanne McGuire
Affiliations

Enhanced cortisol increase upon awakening is associated with greater pain ratings but not salivary cortisol or soluble tumor necrosis factor-α receptor II responses to acute pain

Burel R Goodin et al. Clin J Pain. 2012 May.

Abstract

Objectives: The cortisol awakening response (CAR) is related to psychosocial factors and health in potentially significant ways, suggesting that it may be a distinctive marker of hypothalamic-pituitary-adrenal axis function and dysfunction. This study sought to expand upon previous work that examined the association between CAR and ratings of laboratory-evoked acute pain stimulation. In addition to evoked pain ratings, this study also tested whether CAR was prospectively related with salivary cortisol and soluble tumor necrosis factor-α receptor II responses to acute pain stimulation.

Methods: This study included 36 healthy, pain-free volunteers of both sexes recruited through posted study flyers. Prior to completion of laboratory pain testing, salivary cortisol samples were obtained at home over the course of a single morning according to the following time frame: upon awakening, and 15, 30, and 60 minute after awakening. After collection of saliva, study participants brought their home saliva samples to the laboratory for assay and subsequently completed acute experimental pain testing procedures.

Results: Cluster analysis of CAR revealed two distinct groups with similar patterns of cortisol response to awakening; increased and flattened. Relative to flattened CAR, increased CAR was associated with greater ratings of pain intensity and unpleasantness. Salivary cortisol was significantly increased and soluble tumor necrosis factor-α receptor II significantly decreased after pain testing, but neither of these responses differed as a function of increased versus flattened CAR.

Discussion: CAR may be a marker for stress sensitivity and/or the anticipation of impending stress, which could explain why the increased CAR cohort reported greater acute pain ratings.

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Figures

Figure 1
Figure 1
Anti-log mean values of cortisol response to awakening for the increased (N = 12) and flattened (N = 24) AUCI CAR groups. * = significant increase in cortisol from baseline for the increased AUCI CAR group. + = significant differences between increased and flattened AUCI CAR groups.
Figure 2
Figure 2
Ratings of average and worst pain intensity and pain unpleasantness. * = ratings of increased AUCI CAR group (N = 12) significantly greater than ratings of flattened AUCI CAR group (N = 24).
Figure 3
Figure 3
Anti-log mean values of cortisol response to acute pain. * = cortisol significantly increased from baseline irrespective of CAR group. + = cortisol significantly decreased from baseline irrespective of CAR group.
Figure 4
Figure 4
Anti-log means values of sTNFαRII response to acute pain. * = sTNFαRII significantly decreased from baseline irrespective of CAR group.
See this image and copyright information in PMC

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