Investigating the Impact of Stress on Pain: A Scoping Review on Sense of Control, Social-Evaluative Threat, Unpredictability, and Novelty (STUN Model)

Abstract

Karen Ghoussoub,1,2 Catherine Isadora Côté,2 Maude Fortier,2 Bénédicte Nauche,3 Pierre Rainville,4,5 M Gabrielle Pagé1,2,6 1Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, Quebec, Canada; 2Research Center of the Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada; 3CHUM Library, Centre hospitalier de l’Université de Montreal (CHUM), Montreal, Quebec, Canada; 4Centre de recherche de l’Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de l’île de Montréal, Montreal, Quebec, Canada; 5Department of Stomatology, Université de Montréal, Montreal, Quebec, Canada; 6Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, CanadaCorrespondence: M Gabrielle Pagé, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Tour Saint-Antoine, office S03-910, 850 St-Denis, Montreal, QC, H2X 0A9, Canada, Email [email protected]: Stress can have paradoxical effects on pain, namely hyperalgesia and hypoalgesia. Four situational characteristics activate the hypothalamic–pituitary–adrenal axis, leading to a physiological stress response: lacking Sense of control, social-evaluative Threat, Unpredictability and Novelty (STUN). This scoping review reports on the types of evidence published on the effects of STUN characteristics on pain outcomes.Databases/Data Treatment: Searches of primary electronic databases were performed to identify articles published on adults between 1990 and 2021 that contained search terms on pain and stress/STUN characteristics. A total of 329 articles were included in the analysis.Results: Only 3.3% of studies examined simultaneously > 1 STUN component. Almost all observational studies (177/180) examined the association between perceived stress and pain without measuring physiological stress responses. Of the 130 experimental studies, 78 (60.0%) manipulated stressful characteristics through nociception, and only 38.5% assessed if/how stress manipulation impacted perceived stress.Conclusion: There is a clear lack of integration of the characteristics that trigger a physiological stress response in the pain field. Only 3.3% of studies examined simultaneously more than one STUN component and there is an unequal attention given to individual components of the STUN framework. Recommendations for future research include selection of stress manipulations/measurements that are more precisely inducing/reflecting neurobiological mechanisms of stress responses to insure valid integration of scientific knowledge.Keywords: stress, pain, STUN, control, unpredictability, threat, novelty

Keywords

• stress
• pain
• stun
• control
• unpredictability
• threat
• novelty