Kortisol, subjektive helseplager og mestring blant pasienter med uspesifikke ryggsmerter

Background: Subjective health complaints are prevalent in the Norwegian population, and musculoskeletal pain accounts for the major part of sickness absence. Such non-specific conditions with high comorbidity can be viewed in context with coping with stressful situations, using a cognitive model of stress. Purpose: Investigate how patients with back pain and other subjective health complaints may differ from a normal stress profile of high reactivity in the morning followed by lower evening values, and whether there exists a relationship with coping. The study has a theoretical basis in cognitive activation theory of stress (CATS). Method: Cortisol was measured by saliva samples from 287 low-back patients on sick leave, upon awakening, after 30 minutes, afternoon and evening. Patients answered questionnaires measuring subjective health complaints, instrumental mastery orientation, social support and pain, forming the basis for correlation analyses and t-tests. Results: The sample does not seem to have an abnormal cortisol profile. There were weak relationships between cortisol and some health complaints, social support and pain, in agreement with CATS. However, the group with higher levels of instrumental mastery orientation had significantly higher evening values compared with the lower scoring group. Conclusion: The lack of significant findings is remarkable with respect to the expected relationship between cortisol and health and coping respectively. This may open for reassessments of cortisol as a measure of stress activation, or assumptions related to advantageousness in terms of activation. The subject requires further investigation, and there are various considerations to be taken into account in future research. Keywords: Cortisol, subjective health complaints, coping, social support, low back patients, pain