CoChat
Sign Up
Cited by 729Stress Responses and CortisolMusculoskeletal pain and rehabilitationPain Management and Treatment

The DOI matches its Crossref record; 76 of the 77 references it cites were found in a registry or an index.

Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation

Open access
Hannibal, Kara E., Bishop, Mark D.·2014·Physical Therapy
DOI 10.2522/ptj.20130597PMC PMC4263906
Open this paper in CoChat — free accountOpen PDF

Abstract

Pain is a primary symptom driving patients to seek physical therapy, and its attenuation commonly defines a successful outcome. A large body of evidence is dedicated to elucidating the relationship between chronic stress and pain; however, stress is rarely addressed in pain rehabilitation. A physiologic stress response may be evoked by fear or perceived threat to safety, status, or well-being and elicits the secretion of sympathetic catecholamines (epinephrine and norepinepherine) and neuroendocrine hormones (cortisol) to promote survival and motivate success. Cortisol is a potent anti-inflammatory that functions to mobilize glucose reserves for energy and modulate inflammation. Cortisol also may facilitate the consolidation of fear-based memories for future survival and avoidance of danger. Although short-term stress may be adaptive, maladaptive responses (eg, magnification, rumination, helplessness) to pain or non–pain-related stressors may intensify cortisol secretion and condition a sensitized physiologic stress response that is readily recruited. Ultimately, a prolonged or exaggerated stress response may perpetuate cortisol dysfunction, widespread inflammation, and pain. Stress may be unavoidable in life, and challenges are inherent to success; however, humans have the capability to modify what they perceive as stressful and how they respond to it. Exaggerated psychological responses (eg, catastrophizing) following maladaptive cognitive appraisals of potential stressors as threatening may exacerbate cortisol secretion and facilitate the consolidation of fear-based memories of pain or non–pain-related stressors; however, coping, cognitive reappraisal, or confrontation of stressors may minimize cortisol secretion and prevent chronic, recurrent pain. Given the parallel mechanisms underlying the physiologic effects of a maladaptive response to pain and non–pain-related stressors, physical therapists should consider screening for non–pain-related stress to facilitate treatment, prevent chronic disability, and improve quality of life.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.2522/ptj.20130597

Cites

76 of 76 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

Flagged first, then by citations

Show all 77 references

1 of the 77 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Items 601–700 of 728

Related

See all

Metadata

Authors
Hannibal, K. E., & Bishop, M. D.
Affiliations
University of Florida (US)
Corresponding author
Hannibal, Kara E.
ORCID
Bishop, Mark D.
Venue
Physical Therapy
Publisher
Oxford University Press (OUP)
Published
2014-12-01
Volume
94
Issue
12
Pages
1816-1825
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
DOI
10.2522/ptj.20130597
PMC
PMC4263906
OpenAlex
W2104399350
Cited by
729
References
77
Citations by year
2026: 75 · 2025: 141 · 2024: 93 · 2023: 97 · 2022: 75 · 2021: 74 · 2020: 70 · 2019: 36 · 2018: 25 · 2017: 17 · 2016: 13 · 2015: 10
FWCI
6.55
Type
journal article
Language
en
Open access
Locations
  • Physical Therapy (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Center for Complementary and Integrative Health (AT006334, R01AT006334)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
chronic stress, pain, stress management, pain rehabilitation, fear-avoidance beliefs, pain catastrophizing, cognitive reappraisal, maladaptive stress response, inflammation, stress screening
MeSH terms
Adaptation, Psychological, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pain, Pituitary-Adrenal System, Stress, Physiological, Stress, Psychological

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review