Neck Solutions

Similarities in stress physiology among patients with chronic pain and headache disorders: evidence for a common pathophysiological mechanism?

From: The Journal of Headache and Pain. 2008 Apr 14 [Epub ahead of print]

One common feature of chronic musculoskeletal pain and headaches are that they are both influenced by stress. Among these, tension headache, fibromyalgia and chronic neck and shoulder pain appear to have several similarities, both with regard to pathophysiology, clinical features and demographics. The main hypothesis of the present study was that patients with chronic pain (tension headache, fibromyalgia and shoulder neck pain) had stress-induced features distinguishing them from migraine patients and healthy controls. We measured pain, blood pressure, heart rate (HR) and skin blood flow (BF) during (1 h) and after (30 min) controlled low-grade cognitive stressor in 22 migraine patients, 18 tension headache patients, 23 fibromyalgia patients, 29 shoulder neck pain patients and 44 healthy controls. fibromyalgia patients had a lower early HR response to stress than migraine patients, but no differences were found among fibromyalgia, tension headaches, shoulder and neck pain patients. Finger skin BF decreased more in fibromyalgia patients compared to migraine patients, both during and after the test. When comparing chronic pain patients (chronic tension headaches, fibromyalgia and shoulder neck pain) with those with episodic pain (episodic tension headache and migraine patients) or little or no pain (healthy controls), different adaptation profiles were found during the test for systolic and diastolic blood pressure, HR and skin BF in the chronic group. In conclusion, these results suggest that tension headache, fibromyalgia and shoulder neck pain patients may share common pathophysiological mechanisms regarding the physiological responses to and recovery from low-grade cognitive stress, differentiating them from episodic pain conditions such as migraine.