Due to disparate findings across the published studies, the stress-hyperactivity hypothesis has never been fully accepted as a causal mechanism for chronic muscle pain. Two recent comprehensive reviews of the psychophysiological studies of chronic pain came to opposite conclusions about the viability of the hypothesis, which stemmed from differing importance placed on the experimental methodology: the adequacy of stress manipulation. The present study tested the hypotheses that the adequacy of stress manipulation is influenced by stress stimuli type, degree of personal relevance, and selection of criterion for verification of stress experience, and that these factors have a measurable impact on the related physiological responses in a manner that is consistent with a theory of stress applicable to clinical stress disorders. The three factors investigated were: task (imagery, reaction time), relevance (high, low), and manipulation criterion (autonomic, self-report). The tasks were presented to 16 chronic pain patients while muscle, electrodermal, and self-report responses were recorded. Reaction-time tasks and high-relevance conditions led to high muscle and electrodermal responses. Only the high-relevance imagery, however, produced high self-reported distress. Consistent with other research, the present overall data demonstrated differing physiological profiles for different stimuli types. More importantly, these data suggest that the manipulation type and the manipulation criterion influence outcomes of experimental tests of stress on physiological systems, which may directly lead to contrasting conclusions about causal relations between stress and chronic pain conditions.

Berntson GG, Cacioppo JT, Quigley KS (1991). Autonomic determinism: the modes of autonomic control, the doctrine of autonomic space, and the laws of autonomic constraint . Psychol Rev 98:459-487. Crossref, Medline
Blascovich J. (1992). A biopsychosocial approach to arousal regulation . J Soc Clin Psychol 11:213-237. Crossref
Blascovich J., Ginsburg GP (1978). Conceptual analysis of risk-taking in 'risky-shift' research. J Theory Soc Behav 8:217-229. Crossref
Blascovich J., Kelsey RM (1990). Using electrodermal and cardiovascular measures of arousal in social psychological research. In: Research methods in personality and social psychology. Hendrick C, Clark MS, editors. Newbury Park: Sage Publications, pp. 45-73.
Bray JH, Maxwell SE (1985). Multivariate analysis of variance. Beverly Hills, CA: Sage Publications. Crossref
Bundy RS, Mangan SM (1979). Electrodermal indices of stress and cognition: possible hydration artifacts. Psychophysiology 16:30-33. Crossref, Medline
Cacioppo JT, Petty RE, Marshall-Goodell B. (1984). Electromyographic specificity during simple physical and attitudinal tasks: location and topographical features of integrated EMG responses. Biol Psychol 18:85-121. Crossref, Medline
Carlson CR, Collins FL Jr, Stewart JF, Porzelius J., Nitz JA, Lind CO ( 1989). The assessment of emotional reactivity: a scale development and validation study. J Psychopath Behav Assess 11:313-325. Crossref
Carlson CR, Okeson JP, Falace DA, Nitz AJ, Curran SL, Anderson D. (1993). Comparison of psychologic and physiologic functioning between patients with masticatory muscle pain and matched controls. J Orofacial Pain 7:15-22. Medline
Cohen G. (1990). Why is it difficult to put names to faces? Br J Psychol 81:287-297. Crossref
Dientsbier RA (1989). Arousal and physiological toughness: implications for mental and physical health. Psychol Rev 96:84-100. Crossref, Medline
Dubner R., Bennett GJ (1983). Spinal and trigeminal mechanisms of nociception . Ann Rev Neurosci 6:381-418. Crossref, Medline
Dworkin SF (1994). Somatization, distress and chronic pain. Qual Life Res 3(Suppl 1):S77-S83. Crossref, Medline
Dworkin SF, LeResche L. (1992). Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Dis Fac Oral Pain 6:301-355. Medline
Dworkin SF, Chen AC, Schubert MM, Clark DW (1984). Cognitive modification of pain: information in combination with N2O. Pain 19:339-351. Crossref, Medline
Dworkin SF, Von Korff MR, LeResche L. (1992). Epidemiologic studies of chronic pain: a dynamic-ecologic perspective. Ann Behav Med 14:3-11.
Epstein S. (1984). Controversial issues in emotion theory. Rev Person Soc Psychol 5:64-88.
Feuerstein M., Bush C., Corbisiero R. (1982). Stress and chronic headache: a psychophysiological analysis of mechanisms. J Psychosom Res 26:167-182. Crossref, Medline
Flor H., Turk DC ( 1989). Psychophysiology of chronic pain: do chronic pain patients exhibit symptom-specific psychophysiological responses? Psychol Bull 105:215-259. Crossref, Medline
Flor H., Turk DC, Birbaumer N. (1985). Assessment of stress-related psychophysiological reactions in chronic back pain patients. J Consult Clin Psych 53:354-364. Crossref, Medline
Flor H., Birbaumer N., Schulte W., Roos R. ( 1991). Stress-related electromyographic responses in patients with chronic temporomandibular pain. Pain 46:145-152. Crossref, Medline
Flor H., Birbaumer N., Schugens MM, Lutzenberger W. (1992). Symptom-specific psychophysiological responses in chronic pain patients. Psychophysiology 29:452-460. Crossref, Medline
Fordyce WE, Lansky D., Calsyn DA, Shelton JL, Stolov WC, Rock DL ( 1984). Pain measurement and pain behavior. Pain 18:53-70. Crossref, Medline
Fowles DC, Christie MJ, Edelberg R., Grings WW, Lykken DT, Venables PH (1981). Committee report. Publication recommendations for electrodermal measurements. Psychophysiology 18:232-239. Crossref, Medline
Fridlund AJ, Cacioppo JT (1986). Guidelines for human electromyographic research . Psychophysiology 23:567-589. Crossref, Medline
Genkina OA, Shostakovich GS, Kurella B. (1990). Effect of meaningful stimulus probability on cortical evoked activity in healthy subjects and alcoholics. Human Physiology 16:12-17.
Haynes SN, Gannon LR, Cuevas J., Heiser P., Hamilton J., Katranides M. (1983). The psychophysiological assessment of muscle-contraction headache subjects during headache and nonheadache conditions. Psychophysiology 20:393-399. Crossref, Medline
Horowitz MJ (1975). Intrusive and repetitive thoughts after experimental stress. Arch Gen Psychiat 32:1457-1463. Crossref, Medline
Horowitz M., Wilner N., Alvarez W. (1979). Impact of event scale: A measure of subjective stress. Psychosom Med 41:209-218. Crossref, Medline
Horowitz MJ, Weiss DS, Marmor C. (1987). Diagnosis of posttraumatic stress disorder. J Nerv Ment Dis 175:267-268. Medline
Horowitz MJ, Field NP, Classen CC (1993). Stress response syndromes and their treatment . In: Handbook of stress: theoretical and clinical aspects . 2nd ed. Goldberger L, Breznitz S, editors. New York: Free Press, pp. 757-773.
Hursey KG, Holroyd KA, Penzien DB, Holm JE ( 1985). The influence of pain state on physiological reactivity of tension headache sufferers. Headache 25:79-84. Crossref, Medline
International Association for the Study of Pain-Subcommittee on Taxonomy (1986). Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms . Pain 3(Suppl):S1-S226. Medline
Intrieri RC, Jones GE, Alcorn JD (1994). Masseter muscle hyperactivity and myofascial pain dysfunction syndrome: a relationship under stress. J Behav Med 17:479-500. Crossref, Medline
Jorum E. (1988). Analgesia or hyperalgesia following stress correlates with emotional behavior in rats. Pain 32:341-348. Crossref, Medline
Kapel L., Glaros AG, McGlynn FD (1989). Psychophysiological responses to stress in patients with myofascial pain-dysfunction syndrome. J Behav Med 12:397-406. Crossref, Medline
Katon W., Lin E., Von Korff M., Russo J., Lipscomb P., Bush T. ( 1991). Somatization: a spectrum of severity. Am J Psychiat 148:34-40. Crossref, Medline
Katz JO, Rugh JD, Hatch JP, Langlais RP, Terezhalmy GT, Borcherding SH (1989). Effect of experimental stress on masseter and temporalis muscle activity in human subjects with temporomandibular disorders . Arch Oral Biol 34 :393-398. Crossref, Medline
Keefe FJ, Dunsmore J. (1992). Pain behavior: concepts and controversies. APS J 1:92-100. Crossref
Kelley HH (1984). Affect in interpersonal relations. Rev Person Soc Psychol 5:89-115.
Kirmayer L. (1986). Somatization and the social construction of illness experience. In: Illness behavior. McHugh S, Vallis TM, editors. New York: Plenum Press, pp. 111-133. Crossref
Lacey JI (1967). Somatic response patterning and stress: some revisions of activation theory. In: Psychological stress: issues in research . Appley MH, Trumbull R, editors. New York: Appleton-Century-Crofts, pp. 14-37.
Lang PJ, Kozak MJ, Miller GA, Levin DN, McClean A. Jr (1980). Emotional imagery: conceptual structure and pattern of somato-visceral response. Psychophysiology 17:179-192. Crossref, Medline
Lang PJ, Levin DN, Miller GA, Kozak MJ (1983). Fear behavior, fear imagery, and the psychophysiology of emotion: The problem of affective response integration. J Abnormal Psychol 92:276-306. Crossref, Medline
Lazarus RS, Folkman S. (1984). Stress, appraisal, and coping. New York: Springer Publishing Company.
LeResche L., Burgess J., Dworkin SF (1988). Reliability of visual analog and verbal descriptor scales for "objective" measurement of temporomandibular disorder pain. J Dent Res 67:33-36. Link
Loftus GR, Masson Mej (1994). Using confidence intervals in within-subject designs . Psychonomic Bull Rev 1:476-490. Crossref, Medline
Lund JP, Donga R., Widmer CG, Stohler CS (1991). The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 69:683-694. Crossref, Medline
Lykken DT, Venables PH (1971). Direct measurement of skin conductance: a proposal for standardization. Psychophysiology 8:656-672. Crossref, Medline
MacLeod C., Rutherford EM (1992). Anxiety and the selective processing of emotional information. Mediating roles of awareness, trait and state variables, and personal relevance of stimulus materials. Behav Res Ther 30:479-491. Crossref, Medline
Moulton B., Spence SH (1992). Site-specific muscle hyper-reactivity in musicians with occupational upper limb pain. Behav Res Ther 30:375-386. Crossref, Medline
Nikula R., Klinger E., Larson-Gutman MK (1993). Current concerns and electrodermal reactivity: responses to words and thoughts. J Personality 60:63-84. Crossref
Ohrbach R., McCall WD Jr (1996). The stress-hyperactivity-pain theory of myogenic pain: proposal for a revised theory. Pain Forum 5:51-66. Crossref
Pitman RK, Orr SP, Forgue DF, de Jong JB, Claiborn JM (1987). Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Arch Gen Psychiat 44:970-975. Crossref, Medline
Pitman RK, Orr SP, Forgue DF, Altman B., de Jong JB, Herz LR ( 1990). Psychophysiologic responses to combat imagery of Vietnam veterans with posttraumatic stress disorder versus other anxiety disorders . J Abnormal Psychol 99:49-54. Crossref, Medline
Price DD, Barrell JJ (1984). Some general laws of human emotion: Interrelationships between intensities of desire, expectation, and emotional feeling. J Personality 52:389-409. Crossref
Rimehaug T., Svebak S. (1988). Psychogenic muscle tension: the significance of motivation and negative affect in perceptual-cognitive task performance. Int J Psychophys 5:97-106. Crossref
Rugh JD, Montgomery GT (1987). Physiological reactions of patients with TM disorders vs symptom-free controls on a physical stress task. J Craniomandib Disord Facial Oral Pain 1:243-250. Medline
Schroeder H., Siegmund H., Santigáñez G., Kluge A. (1991). Causes and signs of temporomandibular joint pain and dysfunction: an electromyographical investigation. J Oral Rehabil 18:301-310. Crossref, Medline
Schwartz GE, Brown S., Ahern GL (1980). Facial muscle patterning and subjective experience during affective imagery: sex differences. Psychophysiology 17:75-82. Crossref, Medline
Siegel DJ (1995). Memory, trauma, and psychotherapy: a cognitive science view. J Psychother Pract Res 4:93-122.
Teigen KH (1994). Yerkes-Dodson: a law for all seasons. Theory and Psychology 4:525-547. Link
Thoits PA (1984). Coping, social support, and psychological outcomes: the central role of emotion. Rev Person Soc Psychol 5:219-238.
Thompson JK, Adams HE (1984). Psychophysiological characteristics of headache patients. Pain 18:41-52. Crossref, Medline
Tomaka J., Blascovich J., Kelsey RM, Leitten CL (1993). Subjective, physiological, and behavioral effects of threat and challenge appraisal. J Person Soc Psych 65:248-260. Crossref
Turk DC, Flor H. ( 1987). Pain greater than pain behaviors: the utility and limitations of the pain behavior construct. Pain 31:277-298. Crossref, Medline
Waters WF, Williamson DA, Bernard BA, Blouin DC, Faulstich ME (1987). Test-retest reliability of psychophysiological assessment. Behav Res Ther 25:213-221. Crossref, Medline
Waters WF, McAnulty DP, Buss RR ( 1989). The autonomic nervous system response inventory (ANSRI): discrimination among migraine headache sufferers, muscle contraction headache sufferers, and normal controls. J Psychosom Res 33:549-559. Crossref, Medline
Watson D., Pennebaker JW (1989). Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychol Rev 96:234-254. Crossref, Medline
Yemm R. ( 1969). Temporomandibular dysfunction and masseter muscle response to experimental stress. Br Dent J 127:508-510. Medline
Yemm R. ( 1971). Comparison of the activity of left and right masseter muscles of normal individuals and patients with mandibular dysfunction during experimental stress. J Dent Res 50:1320-1323. Link
Zaslav MR (1994). Psychology of comorbid posttraumatic stress disorder and substance abuse: lessons from combat veterans. J Psychoactive Drugs 26:393-400. Crossref, Medline
Zilberg NJ, Weiss DS, Horowitz MJ (1982). Impact of Event Scale: A cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes. J Consult Clin Psych 50:407-414. Crossref, Medline

Vol 77, Issue 10, 1998

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Psychophysiological Assessment of Stress in Chronic Pain: Comparisons of Stressful Stimuli and of Response Systems

R. OhrbachDepartment of Oral Diagnostic Sciences, 355 SquireJ. BlascovichDepartment of Psychology, University at Buffalo, Buffalo, NY 14214E.N. GaleDepartment of Oral Diagnostic Sciences, 355 SquireW.D. McCall, JrDepartment of Oral Diagnostic Sciences, 355 SquireS.F. DworkinDepartments of Oral Medicine and Psychiatry & Behavioral Sciences, University of Washington, Seattle

Journal of Dental Research

Vol 77, Issue 10, pp. 1840 - 1850

First published date: November-08-2016

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