Development of the Yale pain stress test to elicit a multi-level stress response and assess stress adaptability

High levels of stress and acute stress responses are significant predictors of chronic illnesses; however, specific stress response components of resilience and healthy coping are not well understood.

To develop and assess a pain stress test (Yale Pain Stress Test - YPST) involving three uncontrollable and unpredictable consecutive 3-minute trials of pain-stress (0 °C ice + water) or no pain-stress control (37 °C warm water) hand immersion conditions, adapted from the Cold Pressor Task (CPT).

Fifty men and women participated in a within-subjects experiment. Repeated autonomic [pulse, systolic and diastolic blood pressure (SBP/DBP)], hypothalamic pituitary adrenal (HPA) axis (cortisol, ACTH) and subjective stress (self-reported pain, anxiety) measures during the pre-stress baseline, acute reactivity and return to homeostasis/recovery time periods were collected. Behavioral pain tolerance per trial (in seconds) was also assessed.

Robust multi-level stress responses were observed (p's < 0.009), with sex-specific interactions only for SBP, DBP and pain ratings. Greater reactivity in SBP, DBP, cortisol, and Cortisol/ACTH ratio predicted higher behavioral pain tolerance (p's < 0.038), and higher DBP predicted lower pain during recovery in the pain-stress condition (p < .028). Higher SBP, DBP, Cortisol, and ACTH reactivity in pain-stress but not control predicted lower basal anxiety during recovery (p's < 0.004).

These findings indicate robust multi-level stress responses with YPST provocation, that were also significantly related to behavioral pain tolerance and subjective distress and recovery. The results suggest that acute physiological stress responses play a role in stress adaptability and resilient coping, but replication in larger samples and in individuals suffering from stress-related illnesses is warranted.