The association between changes in pressure pain sensitivity and changes in cardiovascular physiological factors associated with persistent stress

Abstract

Objectives. To evaluate the possible association between pressure pain sensitivity of the chest bone (PPS) and cardiovascular physiological factors related to persistent stress in connection with a three-month PPS-guided stress-reducing experimental intervention programme. Methods. Forty-two office workers with an elevated PPS (≥ 60 arbitrary units) as a sign of increased level of persistent stress, completed a single-blinded cluster randomized controlled trial. The active treatment was a PPS (self-measurement)-guided stress management programme. Primary endpoints: Blood pressure (BP), heart rate (HR) and work of the heart measured as Pressure-Rate-Product (PRP); Secondary endpoints: Other features of the metabolic syndrome. Results. PPS decreased and changes in PPS after the intervention period were significantly associated with HR, PRP, body mass index (BMI) and visceral fat index (all correlation coefficients > 0.2, p < 0.05). Compared to the control cluster group, the active cluster group obtained a significant reduction in PPS, Low-density lipoprotein (LDL) cholesterol and total number of elevated risk factors (p < 0.05). On an individual level, significant and clinically relevant between-group reductions were observed in respect to BP, HR, PRP, total and LDL cholesterol, and total number of elevated risk factors (p < 0.05). Conclusions. The stress intervention method applied in this study induced a decrease in PPS which was associated with a clinically relevant decrease in resting blood pressure, heart rate, work of the heart and serum cholesterols.

Key Words::

• Stress
• pressure pain threshold
• blood pressure
• heart rate
• pressure-rate-product
• BMI
• cholesterol

Acknowledgements

In the pilot study, we wish to thank Anne Margrethe Dahl, the Royal Danish Opera Academy for conducting all instructions and contacts to the students in the active group as well as for allocation of study for the active group. We wish to thank Eva Hess Thaysen, The Royal Danish Academy of Music, for help with conducting and allocating the study for the control group. We wish to thank Charlotte Christiansen for help with carrying out the study in office workers. The lab technicians from Department of Endocrinology 54O4, Herlev University Hospital are thanked for their skillful job concerning blood sampling and measurements. We wish to thank the insurance broker Willis Ltd for an unrestricted financial funding. For statistical analysis with regard to Cluster Randomization design we thank Bjarne Ersboell, Department of Applied Mathematics and Computer Science, Technical University of Denmark.

Disclosures

Dr Søren Ballegaard is shareholder of the company Ull Care A/S, who holds the patent of the instrument, Ull meter, used in this study to measure pressure pain sensitivity. No other author holds financial interest.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.