In a study to estimate the prevalence and population impact of work-related neck and upper limb pain in 10,000 adults in UK, it was found that there were significant independent associations between neck and upper limb pain and: repeated lifting of heavy objects; prolonged bending of neck; working with arms at/above shoulder height; little job control; and little supervisor support. Neck and upper limb pain is associated with both physical and psychosocial factors in the work environment. Findings suggested that modification of the work environment might prevent up to one in three of cases of neck and upper limb pain in the general population, depending on current exposures to occupational risk1.
The prognostic factors for developing chronic low back pain (LBP) at an early stage of LBP include those patients with neurological signs compared to those without neurological signs, those with sickness absence due to LBP and those with emotional distress2.
Chronic stress/depression may contribute to a dysregulation of neuro-endocrine, immune and central painmechanisms in fibromyalgia3.
A study examined the specificity of the relationship between anxiety sensitivity (AS), a measure of catastrophizing about arousal-related sensations, and pain responses, by examining the effect of AS on responses to stressors of a physical and social nature. Healthy men and women (n = 129) between the ages of 18 and 25 years were recruited from the community to participate in a study examining subjective, cognitive and behavioral responses to different types of stressors.
Participants were randomly assigned to one of 3 groups: (i) a neutral condition in which they sat quietly and read a popular magazine; (ii) a social stresscondition in which they anticipated having to give a self-disclosing speech; and (iii) a physical stress condition in which they were presented with 3 countdown to shock trials where a mild electrical shock was administered on the non-dominant arm. Subjective ratings and physiological responses were recorded in anticipation of the stressor and immediately after stress exposure.
Results indicated that AS was indirectly related to pain ratings via its effect on anticipatory anxiety ratings. AS was associated with anticipatory anxiety ratings, regardless of whether the stressor was of a physical or social nature. Furthermore, AS was not shown to be directly associated with exaggerated subjective or physiological reactions to the physical stressor. These results indicate that the role of AS in pain responses may be mediated through a global effect on anxiety, and limited to the anticipatory stage of the pain experience. If future studies yield similar findings in pain patients, then they would suggest that interventions for helping individuals high in AS should focus on catastrophic thinking in anticipation of stressors in general, rather than on pain-specific stressors4.
1. Sim J. Lacey RJ. Lewis M. The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study. BMC Public Health. 6:234, 2006.
2. Grotle M. Brox JI. Glomsrod B. Lonn JH. Vollestad NK. Prognostic factors in first-time care seekers due to acute low back pain. European Journal of Pain: Ejp. 11(3):290-8, 2007 .
3. Van Houdenhove B. Luyten P. Stress, depression and fibromyalgia. Acta Neurologica Belgica. 106(4):149-56, 2006 Dec.
4. Conrod PJ. The role of anxiety sensitivity in subjective and physiological responses to social and physical stressors. Cognitive Behaviour Therapy. 35(4):216-25, 2006