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Cortisol as an indicator of change in the treatment of chronic pain

Evans, Kimberly David (2003) Cortisol as an indicator of change in the treatment of chronic pain. Masters by Coursework thesis, Murdoch University.

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Chronic pain is a biopsychosocial disorder. Psychosocial stress in pa1ticular plays a prominent role in the progression from an acute injury to a chronic pain disorder, as well as the maintenance of a chronic pain disorder. Multidisciplinary treatment is indicated for chronic pain disorders, with significant contribution from psychologists. Treatment efficacy is typically assessed with the use of self-report psychometric instruments, but these are subjective and thus not free of bias. Cortisol is a hormone released by the adrenal cortex in response to stress, and has been suggested as a potential objective indicator of efficacy in the treatment of chronic pain. Some research has shown that cortisol levels are elevated in chronic pain patients, particularly upon waking when cortisol levels are at their peak. However, with the exception of an inconclusive study employing cortisol as an indicator of efficacy in the use of massage therapy for treating chronic pain, this potential has not been investigated.

Eighteen chronic pain patients being treated in the Fremantle Hospital Pain Clinic's Pain Understanding and Management Programme (PUMP) collected saliva samples over several days, four times a day, before and after treatment. Samples were assayed for their cortisol concentration. Results showed that while mean cortisol levels were not overall elevated compared to normative data prior to treatment, there was a significant relationship between intensity of pain and cortisol levels upon waking and late in the evening. Average cortisol levels did not decrease after treatment, but decreases in pain perception were significantly associated with decreases in waking cortisol levels, but not those late in the evening. These results suggest that cortisol shows promise as an objective indicator of efficacy in the treatment of chronic pain, although replication with a randomised and controlled experimental design is now required.

Results also showed that chronic pain patients often experience abnormally high peaks in cortisol levels during the day, when levels are expected to attenuate. This supports the view that stress is a significant problem for chronic pain sufferers. Research has shown that relaxation techniques are effective in reducing cortisol levels in a variety of populations. It is recommended that the PUMP devote more attention to the practice and promotion of the relaxation techniques it employs.

Item Type: Thesis (Masters by Coursework)
Murdoch Affiliation(s): School of Psychology
Notes: Note to the author: If you would like to make your thesis openly available on Murdoch University Library's Research Repository, please contact: Thank you.
Supervisor(s): Drummond, Peter and Bruce, N.
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