ASSOCIATION OF CHRONIC STRESS AND RESPONSES TO ACUTE STRESS IN MEN

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 假设： 1. 通过比较慢性盆腔疼痛综合征（CPPS）受试者与正常对照者的心理社会变量（压力、情感和人格特质），可以确定介导慢性盆腔疼痛综合征（CPPS）发病的风险因素。 2. 作为下丘脑-垂体-肾上腺（HPA）轴活动/失调的指标，游离皮质醇对觉醒的反应的测量将由于实验诱导的急性社会应激而改变。 3. 应激将诱导免疫细胞功能和与HPA轴和皮质醇反应相关的细胞因子分泌的改变。 目标： 应激引发了一系列病理生理事件，这些事件涉及HPA轴的破坏，这可能与CPPS的发展和持续有关。生理应激反应的慢性激活诱导假定的糖皮质激素抵抗和免疫改变，释放促炎细胞因子和胰头素，可能导致盆腔紧张性肌痛，并最终导致骑自行车的心理困扰。没有系统的评价生理作用的急性和慢性应激的发病机制CPPS在男性已进行，然而，临床医生有轶事观察到，压力加剧症状。某些固有的人格特征（遗传和发育因素）调节对压力的反应。我们从CPPS患者中获得了强有力的初步证据，表明物理肌筋膜松解和认知行为疗法，缓解压力的有效方法，在一些CPPS患者中提供了治愈和部分缓解疼痛的方法。了解压力诱导的神经生化变化如何引起男性盆腔疼痛可能会导致开发新的和创新的方法来预防和治疗CPPS。 实验设计： 我们计划在斯坦福大学每年招募24至32名受试者参与这项压力分析辅助研究。正常对照受试者队列将从斯坦福大学社区招募，并与本研究中患有慢性前列腺炎/慢性盆腔疼痛综合征（CP/CPPS）的受试者年龄匹配。将在基线访视当天提供压力和心理调查、用于皮质醇的唾液采集管和说明。参加特里尔急性应激试验，收集唾液皮质醇和血液样本将在两到三周后进行。 具体目标1：CPPS受试者与对照组的心理社会变量（压力、情感和人格特质）关系的表征和调查。 具体目标2：唾液皮质醇反应的测量。将在醒来时和在家庭/工作环境中的正常一天中获得样本。然后受试者接受实验性急性应激测试，我们在斯坦福大学的GCRC收集唾液皮质醇样本和血液样本。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypotheses: 1. Risk factors that mediate the onset of chronic pelvic pain syndrome (CPPS) may be identified by comparing psychosocial variables (stress, affect and personality traits) in subjects with CPPS vs. normal controls. 2. Measurement of free cortisol responses to awakening, as an index of hypothalamic-pituitary adrenal (HPA) axis activity/dysregulation, will be changed as a result of experimentally-induced acute social stress. 3. Stress will induce alterations in immune cell function and cytokine secretion associated with the HPA axis and cortisol response. Goals: Stress triggers a cascade of pathophysiological events that involve disruption of the HPA axis which may be linked to the development and persistence of CPPS. Chronic activation of the physiologic stress response induces putative glucocorticoid resistance and altered immunity, release of proinflammatory cytokines and prostaglandins that may contribute to pelvic tension myalgia, and ultimately to cycling psychological distress. No systematic evaluation of the physiological role of acute and chronic stress in pathogenesis of CPPS in men has been undertaken, however, clinicians have anecdotally observed that stress exacerbates symptoms. Certain inherent personality traits (genetic and developmental factors) modulate reactivity to stress. We have strong preliminary evidence from our CPPS patients indicating that physiotherapeutic myofascial release and cognitive behavioral therapy, proven methods to relieve stress, have provided both curative and partial relief of pain in some CPPS sufferers. Knowledge of how stress-induced neurobiochemical changes evoke pelvic pain in men may lead to development of new and innovative approaches for the prevention and treatment of CPPS. Experimental Design: We intend to enroll 24 to 32 subjects per yr at Stanford to participate in this stress analysis ancillary study. The cohort of normal control subjects will be recruited from the Stanford community area and age-matched with the subjects in this study with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). The stress and psychological surveys, saliva collection tubes for cortisol and instructions will be provided on the day of baseline visit. Participation in the Trier Acute Stress Test with collection of salivary cortisol and blood samples will occur two to three weeks later. Specific Aim 1: Characterization and investigation of the relationships of psychosocial variables (stress, affect, and personality traits) in subjects with CPPS versus controls. Specific Aim 2: Measurement of salivary cortisol response. Samples will be obtained upon awakening and during a normal day in the home/work setting. Subjects then undergo the experimental acute stress test and we collect salivary cortisol samples and blood samples in the GCRC at Stanford.