The difference of anxiety, depression and cortisol levels in patients with acute and chronic vertebrogenic lumbosacral pain syndrome

Abstract

Introduction. Pain is classified as acute and chronic. Acute pain implies a painful condition with a rapid onset or of a short course, whereas chronic pain is referred to as a painful condition persisting beyond the normal time of healing. Chronic low back pain has also been correlated with stress-induced inflammation. Psychological distress aggravates pain symptoms and pain induces a stress response in the body by releasing cortisol from the adrenal cortex. The aim of the study. To investigate differences in levels of anxiety, depression, and cortisol blood concentration in patients with acute and chronic vertebral-sacral pain syndrome. Our main goal was to encrease our understanding of the development and persistence of acute and chronic back pain, define risk factors and improve treatment strategies for the patients. Materials and methods: We studied cortisol levels in blood plasma, levels of anxiety and depression in patients with back pain and LV-SI intravertebral disk herniation. The group under investigation included 125 patients, including 65 patients with acute, and 60 with chronic pain syndrome. A Visual Analogue Scale (VAS) was used to measure the patient`s pain assessment. Spielbergʼs anxiety test is designed to assess reactive and personal anxiety. Personal anxiety characterizes the degree of a person’s anxiety and emotional tension due to the action of stress factors in general. Reactive anxiety is a patient’s personal condition, which characterizes the degree of his anxiety, and emotional tension in response to the action of a stress factor. The Beck’s Depression Symptoms Questionnaire (BDSQ) includes 21 item, self-report rating inventory that measures characteristic attitudes and symptoms of depression. Results. We found no significant difference according to VAS between groups, at the time of hospitalization, patients in the acute pain group evaluated their pain as 7.15 ± 1.17 points, while in the chronic pain group it was estimated as 6.08 ± 0.96 points (p-value more than 0.05). The concentration of cortisol in blood plasma in the acute pain group patients was 313.3 ± 87.7 mmol/l, and in the chronic pain group – 450.7 ± 121.9 mmol/l, the difference between the groups was insignificant (p-value more than 0.05). The evaluation according to Spielbergʼs anxiety test demonstrated high anxiety levels at the time of examination: in the acute pain group reactive anxiety corresponded to 40.4 ± 12.6 points, in the chronic pain group the same index was 39.5 ± 11.3. Personal anxiety in the group of acute pain was 32.3 ± 13.6, in the group of chronic pain – 41.3 ± 9.7. According to Beck’s Depression Symptoms Questionnaire before the beginning of treatment average score in the acute pain group was estimated as 6.8 ± 1.1 points, while in the chronic pain group this index corresponded to 9.8 ± 0.8 points (probable difference between groups p-value less than 0.05). Comparisons of cortisol concentrations between groups of patients with different levels of pain, anxiety, and depression demonstrated no significant differences. However, cortisol level was higher in the acute pain group among patients who rated their pain syndrome as ʺsevere painʺ (6-7 points according to VAS) (280.2 ± 77.8 mmol/l in the group of acute pain, and 515.0 ± 80.1 mmol/l in the group of chronic pain), as well as among patients with mild depressive symptoms (393.5 ± 19.5 mmol/l in the group with an acute pain compared to 553.1± 68.0 mmol/l in the group with chronic pain syndrome). Conclusions. The study demonstrates differences in pain perception and assessment in patients that suffer from acute and chronic back pain. A high level of personal and reactive anxiety was found among participants. A higher level of depressive symptoms, as well as the disturbances in the diurnal fluctuations of cortisol were detected in the chronic pain group patients.