I am a
Home I AM A Search Login

Papers of the Week

Papers: 11 Nov 2023 - 17 Nov 2023

2023 Nov 11

J Pain


Hydrocortisone differentially affects reinstatement of pain-related responses in patients with chronic back pain and healthy volunteers.


Schmidt K, Schlitt F, Wiech K, Merz CJ, Kleine-Borgmann J, Wolf OT, Engler H, Forkmann K, Elsenbruch S, Bingel U


Despite the crucial role of effective and sustained extinction of conditioned pain-related fear in cognitive-behavioral treatment approaches for chronic pain, experimental research on extinction memory retrieval in chronic pain remains scarce. In healthy populations extinction efficacy of fear memory is affected by stress. Therefore, we investigated the effects of oral hydrocortisone administration on the the reinstatement of pain-related associations in 57 patients with chronic back pain (CBP) and 59 healthy control (HC) participants in a differential pain-related conditioning paradigm within a placebo-controlled, randomized and double-blind design. Participants’ skin conductance responses indicate hydrocortisone-induced reinstatement effects in HCs but no observable reinstatement in HCs receiving placebo treatment. Interestingly, these effects were reversed in patients with CBP, i.e., reinstatement responses were only observed in the placebo and not in the hydrocortisone group. Our findings corroborate previous evidence of stress-induced effects on extinction efficacy and reinstatement of fear memory in HCs extending them into the pain context and call for more research to clarify the role of stress in fear extinction and return of fear phenomena possibly contributing to treatment failure in chronic pain treatment. PERSPECTIVE: Opposing effects in HCs and patients with CBP may be associated with changes in the patients’ stress systems. These findings could be of relevance to optimize psychological, extinction-based treatment approaches.