Helplessness and perceived pain intensity: relations to cortisol concentrations after electrocutaneous stimulation in healthy young men

Sixty-four male volunteers were randomly assigned to receive 30 controllable (self-administered) or uncontrollable (experimenter-administered) painful electric skin stimuli. Perceived pain intensity (PPI), subjective helplessness ratings, and salivary cortisol concentrations were assessed. PPI was assessed after stress exposure. For salivary cortisol concentrations and subjective helplessness ratings, areas under the response curve (AUC) were calculated.After uncontrollable vs. controllable stress exposure significantly higher PPI ratings (P = 0.023), higher subjective helplessness AUC (P < 0.0005) and higher salivary cortisol AUC (P = 0.004, t-tests) were found. Correlation analyses revealed a significant correlation between subjective helplessness AUC and PPI (r = 0.500, P < 0.0005), subjective helplessness AUC and salivary cortisol AUC (r = 0.304, P = 0.015) and between PPI and salivary cortisol AUC (r = 0.298, P = 0.017).The results confirm the impact of uncontrollability on stress responses in humans; the relationship of PPI with subjective helplessness and salivary cortisol suggests a cognitive-affective sensitization of pain perception, particularly under uncontrollable conditions.Uncontrollability of unpleasant life events and aversive stressors seems to be one of the most important determinants of physiological and psychological stress response [1-3]. Learned helplessness theory has shown that repeated exposure to non-contingent feedback, i.e. a lack of correlation between behavior and aversive consequences may lead to negative affective, motivational, and cognitive sequelae including blunted and lowered affect, hopelessness, low self-esteem, motivational deficits and a cognitive bias towards low self-efficacy and controllability expectancies [4,5]. Besides these psychological effects of experiencing uncontrollable stress, activation of the hypothalamic-pituitary-adrenal (HPA) axis, mainly with elevated corticosteroid levels, was repeatedly found after unco