Abstract
Results on hypothalamicpituitary-adrenal (HPA) axis function in fibromyalgia are heterogeneous
and studies that integrate psychological and biological mechanisms in the search for
pathways to fibromyalgia are rare. The goal of the study was to evaluate cortisol
release and HPA axis feedback regulation in fibromyalgia and its association with
psychopathology and pain. Beneath assessment of pain thresholds and self-report of
pain, salivary free cortisol release over the day before and after intake of 0.5 mg
of dexamethasone was measured in 21 female patients with fibromyalgia and 26 control
women. Depression was assessed by questionnaires and clinical interview. We found
reduced feedback sensitivity and slightly enhanced cortisol release in patients with
fibromyalgia compared with healthy control subjects. Post hoc analyses showed that
these effects are exclusively found in those patients, who also had major depressive
disorder. Patients with fibromyalgia had lower pain pressure threshold, whereas heat
pain thresholds were comparable with control subjects. Pain pressure and heat pain
thresholds were not associated with cortisol release. On the other hand measurements
of affective pain experience and depression were positively correlated with salivary
cortisol over the day. Our results support the hypotheses that HPA axis related alterations
are associated with affective disturbances, for example, depression, in patients with
fibromyalgia.
Perspective
The presented data suggest depression to be an important factor in HPA axis–related
dysfunction in fibromyalgia. This might be one explanation for equivocal findings
in the literature.
Key words
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Article info
Publication history
Published online: June 02, 2010
Accepted:
February 22,
2010
Received in revised form:
February 8,
2010
Received:
October 8,
2009
Footnotes
There was no external funding for this study.
There were no conflicts of interest, financial or otherwise, to declare.
Identification
Copyright
© 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.
