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

Abstract

Background

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

Abbreviations

STUN, Sense of control, social-evaluative Threat, Unpredictability, and Novelty; PRISMAScR, Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was funded by a project grant from the Canadian Institutes of Health Research, grant number 436406. MG Pagé is a Junior 2 research scholar from the Fonds de recherche du Québec - santé (FRQS).