Perceived control moderates the influence of active coping on salivary cortisol response to acute pain among women but not men

Summary

It is generally established that active-coping strategies and greater perceived control over pain are associated with improved pain-related outcomes; however, it remains unclear whether these factors independently or interactively influence adrenocortical function in reaction to a painful stimulus. The present study examined whether active coping predicted magnitude cortisol response to acute pain, whether perceived control over pain moderated this association, and whether effects differed as a function of sex. Our findings suggest that perceived control moderates the active coping–adrenocortical relation among women but not men, such that active coping may augment the release of cortisol in response to a painful stimulus only in the presence of greater perceived control over pain. Taken together, active coping and perceived control may potentiate an adaptive neuroendocrine response to an acute painful stressor.

Introduction

The role of cognition in shaping neuroendocrine responses to threat and challenge is receiving increasing attention (Ursin, 1998, Ursin and Eriksen, 2004); however, evidence for cognition-related influences on cortisol production following experimental pain stimulation is limited. It is suggested that men and women may demonstrate divergent responses to noxious stimuli, yet studies of sex differences in HPA axis responses following stressful stimulation have revealed inconsistent patterns of results (see Zimmer et al., 2003 for review). Additional studies are needed to examine whether (and which) cognitive processes might modulate neuroendocrine responses to noxious stressors, and whether these relations vary as a function of sex.

A dynamic HPA axis response following acute noxious stimulation should be considered adaptive as the release of cortisol has widespread actions which help restore homeostasis following a stressful event. In addition to the nature of the stressor, individuals’ cognitions during the stress experience may partially determine the HPA axis response. In clinical samples, passive coping, repression, and denial of a stressful event have been shown to be related to hypocortisolism, a condition believed to be implicated in inflammatory processes that promote the development of cardiovascular disease (Heim et al., 2000). Additionally, a relation between hypercortisolism and impaired cognition (attentional and memory deficits) has been reported, particularly for individuals reporting depressive symptoms (O’Brien et al., 2004). There is currently insufficient evidence describing whether adaptive cognitions, such as active coping and sense of control, may be related to adaptive cortisol responses following noxious stimulation in non-clinical samples.

In this study, we examined active-coping strategies, perceived control over pain, and their interaction with cortisol response. Furthermore, we examined whether these relations varied as a function of sex. It was hypothesized that (1) perceived control over the painful stressor would interact with active-coping strategies in relation to an adaptive cortisol response and (2) given previous literature suggesting sex differences in cortisol response to noxious stress, men and women would demonstrate divergent cortisol responses in relation to perceived control and coping.