Pressure pain sensitivity: A new method of stress measurement in patients with ischemic heart disease

Abstract

Background. Chronic stress is prevalent in patients with ischemic heart disease (IHD) and worsens the long-term prognosis. Chronic stress is vaguely defined, but is associated with depressive symptoms, reduced psychological wellbeing, and reduced quality of life (QOL). Stress seems to induce hyperalgesia.The aim of the present study was to evaluate hyperalgesia by pressure pain sensitivity (PPS) in patients with IHD, and compare PPS to questionnaires measuring depressive symptoms, reduced psychological wellbeing, and QOL as markers of stress. Design. A cross-sectional study of 361 subjects with IHD. Methods. PPS was measured on the sternum, and compared to the questionnaires: Clinical stress symptoms score (CSS), Major Depression Inventory (MDI), WHO-5 Wellbeing Index, and SF-36 QOL score. Results. PPS correlated to CSS (r = 0.20, p < 0.001), MDI (r = 0.14, p = 0.02), SF-36 mental component summary score (MCS) (r = − 0.10, p = 0.049), SF-36 physical component summary score (PCS) (r = − 0.17, p = 0.001), and self-perceived stress level (r = 0.15, p = 0.006). CSS correlated similarly (r = 0.5–0.7, all p < 0.001). Comparing subjects within the lowest vs. highest tertiles of PPS and CSS, the mean MDI score was 4 vs. 15, WHO-5 was 77 vs. 53, SF-36 PCS was 53 vs. 43, and SF-36 MCS was 58 vs. 46; all p < 0.001. Conclusions. PPS reflected to a modest degree markers of chronic stress in IHD. PPS and CSS together might be useful as easy-to use tools for evaluating these markers in IHD patients.

Key Words::

• Depression
• myocardial ischemia
• stress psychological
• questionnaires
• quality of life
• pain

Acknowledgements

We are thankful to the staff of the Metabolic Ward for their contribution: Helle-Marina Oxfeldt, Tine Skogen-Lassen, Ulla Kjærulff-Hansen, Tonni Løve Hansen, Hanne Dorthe Mogensen, Marianne Sørensen og Rikke Mirsbach Henkel.

Disclosures

Søren Ballegaard invented the Ull-meter used to measure PPS. He is also a shareholder of the company that owned the Ull-meter. In order to avoid bias, he was not involved in the patient contact, collection of data or statistical analysis. No other disclosures were reported.

Declaration of interest: This work was supported by the Johan Schrøder's Family and Business Foundation. Natasha Bergmann holds pre-graduate scholarships sponsored by the Lundbeck Foundation, Else and Mogens Wedell-Wedellsborg's Foundation, and Carpenter Sophus Jacobsen and Wife Astrid Jacobsen's Foundation.