Links Between Chronic Pain, Work & Family Interactions, and Stress Hormones

An elderly couple sits in their living room. The man holds his knee, appearing to be in discomfort, while his partner offers support. The image conveys care, concern, and the bond between the couple.Chronic pain is a leading cause of disability worldwide and has significant impacts on people’s lives, including contributing to severe, ongoing stress. This study explored the interactions between chronic pain and work-family interactions, given that work and family are key areas in which people experience stress. It also examined the role of the stress hormone cortisol. Normal patterns of cortisol peak in the morning to provide energy to start the day and decline at bedtime to allow rest. When stress disrupts this normal pattern it can lead to problems with physical and mental health.

Researchers identified 1413 people in the MIDUS study who reported having chronic pain, defined as pain that persisted beyond the time of normal healing and lasted anywhere from a few months to many years. For each individual who reported chronic pain, they also identified a participant who matched them on demographic characteristics such as age, sex, race, and income, but who did not have chronic pain. The researchers considered the following factors:

Work-family spillover: Participants indicated how their work and family lives interacted in the following ways:

  • Negative work to family spillover: how much their job reduced the effort they could give to activities at home. For example, work can make people too tired to complete projects at home.
  • Positive work to family spillover: whether things they did at work helped them deal with personal or practical issues at home. For example, skills learned at work may help people accomplish something similar at home.
  • Negative family to work spillover: how much personal or family worries distracted them at work and reduced the effort they could put into their job.
  • Positive family to work spillover: whether talking with someone at home helped them deal with problems at work, or relaxing at home made them feel ready to return to work.

Stressful events: Over eight days, participants reported how many stressful events they had experienced at work and home, such as arguments, avoided arguments, or something stressful happening to a close friend or relative.

 Cortisol profiles: Saliva samples were collected over four days to measure levels of the stress hormone cortisol. Participants were classified into groups depending on whether their cortisol profiles were:

  • Normal: cortisol levels peaked in the morning and declined at bedtime.
  • Flattened: the morning cortisol peak was lower than normal and evening levels of cortisol were higher.
  • Elevated: cortisol was higher than normal earlier in the day.

Several key findings emerged from the analyzed data:

People with chronic pain reported more negative work to family spillover, meaning that things happening at work negatively affected their home life more than it did for people without chronic pain. The fatiguing aspects of work seemed to be the most important factor in this association, indicating that reducing the type of work that aggravates a person’s chronic pain may possibly help them have more energy at home.

People with chronic pain experienced more stressful home-related events. These were typically with home-related people, such as spouses or other family members, rather than events that happened in the home. Avoiding arguments were a significant portion of these stressful interactions and may be one way of coping with the increased tension that chronic pain may have on close relationships. However, avoiding arguments may also increase relationship tension. This suggests that relationship therapy may be useful in managing chronic pain.

People with chronic pain had increased cortisol levels later in the day. This finding suggests that their bodies stayed in a state of alertness rather than preparing for sleep. When such patterns occur for an extended period, they can lead to poor physical health, such as increased inflammation, or psychological distress, such as depression or anxiety. Stress management practices, such as mindfulness or relaxation techniques, may help in reducing cortisol levels later in the day.

There were no significant differences in cortisol profiles between the chronic and non-chronic pain groups. Contrary to expectations, people with chronic pain did not show significant differences between the normal, elevated, or flattened daily cortisol patterns, suggesting that chronic pain does not affect cortisol profiles in the same way for everyone. Further study is needed to examine possible coping mechanisms among those who have chronic pain but whose cortisol profiles remain normal. So doing could lead to interventions to help others with chronic pain whose cortisol profiles are dysregulated.

Together, these findings illustrate that while chronic pain may influence stress-related outcomes like work-family spillover, the number of home-related stressful events, and cortisol levels at the end of the day, it does not necessarily lead to overall changes in cortisol profiles. Such results point to the need for individualized interventions with multiple approaches that target specific stressors or symptoms, rather than attempting to broadly improve cortisol levels to help those experiencing chronic pain.

Source: Kim, S. Y., Iserman, M., Nguyen, N., & Yoo, H. (2024). Diurnal cortisol patterns in chronic pain: Associations with work-family spillover, work, and home stress. Stress, 27(1), Article 2402954. https://doi.org/10.1080/10253890.2024.2402954

Read the full article at: http://www.midus.wisc.edu/findings/pdfs/2920.pdf