[The cortisol awakening response in patients with acute and chronic low back pain. Relations with psychological risk factors of pain chronicity]. / Die Cortisol-Aufwachreaktion bei Patienten mit akuten und chronischen Rückenschmerzen. Zusammenhänge mit psychologischen Risikofaktoren der Schmerzchronifizierung.

BACKGROUND: Peculiarities of the hypothalamic-pituitary-adrenal axis activity in stress-related pain-disorders and potential relations with psychological risk factors of pain chronicity have been discussed controversially. MATERIAL AND METHODS: The cortisol awakening responses of 31 low back pain patients (14 acute, 17 chronic) and 14 healthy controls were compared. In addition the interrelations between awakening response and chronic stress as well as depressive mood and - for the first time - maladaptive painprocessing and -copingstrategies were investigated. RESULTS: The groups did not differ in their cortisol awakening responses. Chronic stress, depressive mood and maladaptive cognitive painprocessing did not correlate with the awakening response. There were, however, significant interrelations between awakening responses and the behavioral paincoping-strategies. CONCLUSIONS: Behavioral paincoping-strategies should be considered as a potentially important contributing psychological factor in the relation between the activity of the hypothalamic-pituitary-adrenal axis and stress-related pain disorders.