Background Dysfunction of biological stress systems and adverse life events, both independently and in interaction, have been hypothesized to predict chronic pain persistence, but longitudinal evidence is currently lacking.
Objectives We examined whether (i) function of biological stress systems, (ii) adverse life events, and (iii) their combination predict the persistence of chronic multi-site musculoskeletal pain.
Methods 665 subjects of the Netherlands Study of Depression and Anxiety (NESDA) with chronic multi-site musculoskeletal pain at baseline were followed-up 2, 4 and 6 years later. The Chronic pain Grade Questionnaire was used to determine recovery and persistence of chronic multi-site musculoskeletal pain. Baseline assessment of biological stress systems included function of hypothalamic-pituitary-adrenal (HPA)-axis (1-h cortisol awakening response, evening level and post-dexamethasone level), the immune system (IMS; basal and lipopolysaccharide (LPS)-stimulated inflammatory markers), the autonomic nervous system (ANS; heart rate, pre-ejection period, standard deviation of the normal-to-normal interval, respiratory sinus arrhythmia). The number of adverse life events were assessed at baseline and 2-year follow-up using the List of Threatening Events Questionnaire.
Results Function of the HPA-axis, IMS and ANS and adverse life events were not associated with the persistence of chronic multi-site musculoskeletal pain, either as a main effect or in interaction.
Conclusions This longitudinal study could not confirm that altered biological stress systems functioning and adverse life events increase the risk of chronic multi-site musculoskeletal pain persistence. This suggests these two suspects do not hamper recovery once subjects have been sensitized to chronic multi-site musculoskeletal pain.
Disclosure of Interest None declared