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Fibromyalgia syndrome is associated with hypocortisolism
Stockholm University, Faculty of Social Sciences, Department of Psychology.
Norwegian University of Science and Technology, Human Movement Science Programme.
Norwegian University of Science and Technology, Department of Industrial Economics and Technology.
Norwegian University of Science and Technology, Department of Neuroscience.
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2010 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 17, no 3, 223-233 p.Article in journal (Refereed) Published
Abstract [en]

Background: Fibromyalgia syndrome (FMS) is a disease of unknown pathogenesis characterized by chronic musculoskeletal pain. FMS has been also associated with altered endocrinological responses, but findings are inconsistent.

Purpose: The aim of the present study was to investigate free salivary cortisol levels in FMS patients compared with healthy controls with a particular focus on the Cortisol Awakening Response (CAR). The saliva samples were collected in a controlled hospital-hotel setting, in which the participants’ compliance was high and a number of potential confounders were analyzed.

Method: Twenty-nine chronic female FMS patients and 29 age-matched healthy female controls were recruited. Salivary cortisol samples were investigated eight times: in the afternoon when participants arrived at the hospital, after stress provocation (to be reported separately), in the evening, before they went to sleep, upon awakening, 30 and 60 minutes later, and during the afternoon of the second day. Questionnaires measuring pain levels, sleeping problems, perceived stress and personality were administered to the participants. Other psychophysiological measurements were used to assess sleep quality and heart rate.

Results: Patients with FMS had significantly lower cortisol levels during the day, most pronounced in the morning (CAR). The potential confounders analyzed did not influence the results. As expected, FMS patients reported more pain, stress, sleeping problems, anxiety and depression.

Conclusions: The results lend support to the hypothesis of a dysfunction in the Hypothalamus-Pituitary-Adrenal axis in FMS patients, with generally lower cortisol values, most pronounced upon awakening (CAR).

Place, publisher, year, edition, pages
2010. Vol. 17, no 3, 223-233 p.
Keyword [en]
Chronic musculoskeletal pain, stress, salivary cortisol, psychosomatic symptoms
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Research subject
URN: urn:nbn:se:su:diva-65003DOI: 10.1007/s12529-010-9097-6OAI: diva2:460480
Available from: 2011-11-30 Created: 2011-11-30 Last updated: 2011-11-30Bibliographically approved
In thesis
1. Psychobiological responses in women with regional or widespread musculoskeletal pain conditions
Open this publication in new window or tab >>Psychobiological responses in women with regional or widespread musculoskeletal pain conditions
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Musculoskeletal disorders (MSDs) are very common. Regional chronic shoulder and neck pain (SNP) and widespread chronic pain due to fibromyalgia syndrome (FMS) are examples of MSDs characterized by altered physiology of the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. The aims of this thesis are to compare the cortisol awakening response (CAR) in SNP women, FMS patients and healthy controls, and to compare salivary cortisol levels, urinary catecholamine levels (adrenaline, noradrenaline, and dopamine), and cardiovascular responses in FMS patients and healthy controls. Self-ratings of sleep, anxiety, perceived stress, and pain were also investigated. In Study I, CAR tended to be higher in SNP women than in healthy controls, whereas it was significantly higher than in FMS patients. Moreover, CAR was significantly lower in FMS patients than in healthy controls. Study II showed that cortisol levels were lower in FMS patients than in healthy controls during the rest of the day as well. In Study III, adrenaline and dopamine (but not noradrenaline) levels were significantly lower in FMS patients than in healthy controls. Resting heart rate was significantly higher in FMS patients than in healthy controls, but no differences emerged during stress provocation or unconstrained daily activities. Finally, SNP women and FMS patients reported more pain and health complaints than did healthy controls, but SNP women were less affected. Potential confounders (e.g., age, obesity, physical exercise) had no effects on the findings. Taken together, the findings show altered ANS and HPA axis regulation in FMS patients. Specifically, the hyperactive HPA axis found in SNP women (i.e., higher cortisol levels) might constitute a preliminary stage of a hypoactive HPA axis in FMS patients (i.e., lower cortisol levels). In view of this, an altered regulation of the HPA axis in the progression from regional to widespread MSDs may follow a temporal development.

Place, publisher, year, edition, pages
Stockholm: Department of Psychology, Stockholm University, 2012. 96 p.
fibromyalgia, shoulder and neck pain, salivary cortisol, urinary catecholamines, cardiovascular responses
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Research subject
urn:nbn:se:su:diva-65011 (URN)978-91-7447-420-6 (ISBN)
Public defence
2012-02-10, David Magnussonsalen (U31), Frescati Hagväg 8, Stockholm, 10:00 (English)
At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Epub ahead of print. Paper 2: Epub ahead of print.Available from: 2012-01-19 Created: 2011-11-30 Last updated: 2011-12-21Bibliographically approved

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Riva, RobertoLundberg, Ulf
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