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利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 假设： 1.慢性盆腔疼痛综合征(CPPS)发病的危险因素可通过比较慢性盆腔疼痛综合征(CPPS)患者与正常对照组的心理社会变量(压力、情感和人格特征)来确定。 2.作为下丘脑-垂体肾上腺(HPA)轴活动/调节失调的指标，对觉醒的自由皮质醇反应的测量将因实验诱导的急性社会应激而改变。 3.应激可引起免疫细胞功能及与HPA轴和皮质醇反应相关的细胞因子分泌的改变。 目标： 应激引发一系列的病理生理事件，涉及HPA轴的破坏，这可能与CPPS的发展和持久性有关。生理应激反应的慢性激活可能会导致糖皮质激素抵抗和免疫改变，释放促炎细胞因子和前列腺素，这可能会导致盆腔紧张性肌痛，最终导致循环性心理痛苦。对于急性和慢性应激在男性CPPS发病机制中的生理作用，还没有进行系统的评估，然而，临床医生已经根据轶事观察到，应激会加剧症状。某些与生俱来的个性特征(遗传和发育因素)会调节对压力的反应。我们有来自CPPS患者的强有力的初步证据表明，物理治疗性肌筋膜释放和认知行为疗法是被证明的缓解压力的方法，已经为一些CPPS患者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创新方法来预防和治疗CPPS。 实验设计： 我们打算在斯坦福大学每年招收24至32名受试者参加这项压力分析辅助研究。正常对照组受试者将从斯坦福社区招募，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。在基线访问当天将提供压力和心理调查、唾液皮质醇采集管和说明。参加特里尔急性压力测试，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：心理社会变量(压力、情感和人格特征)在CPPS患者和对照组之间的关系的特征和调查。 具体目标2：唾液皮质醇反应的测量。样本将在醒来时和在正常的一天中在家庭/工作环境中获得。然后，受试者接受实验性的急性应激测试，我们收集了斯坦福大学GCRC的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.