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Papandreou M1, Philippou A2, Taso O2, Koutsilieris M2, Kaperda A3
1University of West Attica, Physiotherapy, Athens, Greece, 2National Kapodistrian University of Athens, Physiology, Athens, Greece, 3Athens Chest Diseases Hospital Sotiria, Anaesthetoloy, Athens, Greece
Background: Cortisol is an essential steroid hormone; it is produced in the adrenal cortex within the adrenal gland (Goodin et al 2012; Raff 2011; Chan and Debono 2010). Cortisol increased levels have been associated with pain severity in adult patients with chronic musculoskeletal pain (CMP) (Geiss et al 1999; McBeth et al 2005; Neeck 2000; Carnes et al. 2007; Al'Absi et al 2002). Little is known about the potential association between pain management and salivary cortisol alterations in adult patients with CMP following treatment regimens.
Purpose: This prospective randomized trial study determined the effect of two treatment regimens in comparison with sham therapy on pain intensity levels and salivary cortisol concentration (SCC) in adult patients with CMP.
Methods: 30 patients (53.96±9.65 years, BMI 24.29±3.95 kg/m2) were randomly assigned to 3 groups of 10 each, two experimental (A and B) and a control (C) group. The experimental groups followed physiotherapy treatment (A), or acupuncture (B), while the control one (C) followed a sham therapy for ten sessions. Pain intensity data was collected by a chronic pain graded (CPG) questionnaire and SCC by measuring with ELISA at pretreatment and after the intervention. Repeated measures ANOVA were used to examine the effects of treatment on each outcome variable.
Results: ANOVA showed statistically significant differences within groups (F=27.15, Sig= 0.00, P 0.05) and between groups (F=4.22, S=0.02, P 0.05) in pain intensity. Patients treated with acupuncture experienced greater decreases in pain intensity compared with the physiotherapy treatment and sham therapy groups. No statistically differences were found between the three groups on SCC outcome variable. Hence, Bonferroni adjustments showed that the mean values of SCC were significantly decreased at post-treatment (Mean Difference 1.46, Sig. 0.001, P 0.05) compared with pre-test across the three groups.
Conclusion(s): These results showed a significant decrease in both pain and cortisol outcomes in adult patients with CMP. The acupuncture treatment was found to be related with pain levels reduction in patients with CMP. We cannot draw conclusions whether the lower SCC could be an indication of pain reduction in patients with CMP due to several limitations of this study.
Implications: The clinical implications of this study would provide a clearer understanding of the decision making following specific treatment regimens on pain management in relation with cortisol concentration levels giving the opportunity of evidence based studies in patients with CMP.
Keywords: salivary cortisol, musculoskeletal disorders, pain management
Funding acknowledgements: No funding
Purpose: This prospective randomized trial study determined the effect of two treatment regimens in comparison with sham therapy on pain intensity levels and salivary cortisol concentration (SCC) in adult patients with CMP.
Methods: 30 patients (53.96±9.65 years, BMI 24.29±3.95 kg/m2) were randomly assigned to 3 groups of 10 each, two experimental (A and B) and a control (C) group. The experimental groups followed physiotherapy treatment (A), or acupuncture (B), while the control one (C) followed a sham therapy for ten sessions. Pain intensity data was collected by a chronic pain graded (CPG) questionnaire and SCC by measuring with ELISA at pretreatment and after the intervention. Repeated measures ANOVA were used to examine the effects of treatment on each outcome variable.
Results: ANOVA showed statistically significant differences within groups (F=27.15, Sig= 0.00, P 0.05) and between groups (F=4.22, S=0.02, P 0.05) in pain intensity. Patients treated with acupuncture experienced greater decreases in pain intensity compared with the physiotherapy treatment and sham therapy groups. No statistically differences were found between the three groups on SCC outcome variable. Hence, Bonferroni adjustments showed that the mean values of SCC were significantly decreased at post-treatment (Mean Difference 1.46, Sig. 0.001, P 0.05) compared with pre-test across the three groups.
Conclusion(s): These results showed a significant decrease in both pain and cortisol outcomes in adult patients with CMP. The acupuncture treatment was found to be related with pain levels reduction in patients with CMP. We cannot draw conclusions whether the lower SCC could be an indication of pain reduction in patients with CMP due to several limitations of this study.
Implications: The clinical implications of this study would provide a clearer understanding of the decision making following specific treatment regimens on pain management in relation with cortisol concentration levels giving the opportunity of evidence based studies in patients with CMP.
Keywords: salivary cortisol, musculoskeletal disorders, pain management
Funding acknowledgements: No funding
Topic: Musculoskeletal
Ethics approval required: Yes
Institution: Physiology Research Laboratory of the National Kapodistrian University of Athens
Ethics committee: Prof: Gorgoulis, Tzioufas, Liakakos, Papantoniou, Papageorgiou
Ethics number: 1617006490, 25/10/16
All authors, affiliations and abstracts have been published as submitted.
