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Psychobiological responses in women with regional or widespread musculoskeletal pain conditions
Stockholm University, Faculty of Social Sciences, Department of Psychology.
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.
Keyword [en]
fibromyalgia, shoulder and neck pain, salivary cortisol, urinary catecholamines, cardiovascular responses
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-65011ISBN: 978-91-7447-420-6 (print)OAI: oai:DiVA.org:su-65011DiVA: diva2:460499
Public defence
2012-02-10, David Magnussonsalen (U31), Frescati Hagväg 8, Stockholm, 10:00 (English)
Opponent
Supervisors
Note
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
List of papers
1. Comparison of the cortisol awakening response inwomen with shoulder and neck pain and women with fibromyalgia
Open this publication in new window or tab >>Comparison of the cortisol awakening response inwomen with shoulder and neck pain and women with fibromyalgia
2012 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 37, no 2, 299-306 p.Article in journal (Refereed) Published
Abstract [en]

Shoulder and neck pain (SNP) and fibromyalgia syndrome (FMS), two musculoskeletal conditions of unknown pathogenesis, share some common features in terms of altered neuroendocrine responses, pain and stress perception. However, the pain distribution in SNP is localized,whereas in FMS is more widespread. Because regional musculoskeletal pain may represent an intermediate stage along a continuum towards widespread musculoskeletal pain we compared the cortisol awakening response (CAR) in women with SNP with the CAR in FMS patients and healthy controls (HC) in a controlled hospital—hotel setting. The aim of the study was to investigate whether SNP is related to a deviant regulation of the hypothalamic—pituitary—adrenal (HPA) axis. Eighteen women with SNP, 29 female FMS patients, and 27 female HC participated in the study. Cortisol samples were collected upon awakening, 30 and 60 min later. Questionnaires measuring pain levels, sleeping problems, perceived stress, and psychological characteristics were administered to the participants. Compared with HC, women with SNP had a tendency towards higher cortisol levels, whereas FMS had lower cortisol levels. Adjustment for potential confounders did not influence the results. Women with SNP and FMS patients reported more health complaints, pain, and perceived stress than the HC, but women with SNP were less affected than the FMS patients. Women with SNP showed a tendency towards an elevated HPA axis activity compared with HC. The current findings may indicate that the hypercortisolism in regional musculoskeletal pain represent an intermediate stage towards the development of a hypocortisolism in widespread musculoskeletal pain.

Place, publisher, year, edition, pages
Elsevier, 2012
Keyword
salivary cortisol, hypothalamic—pituitary—adrenal axis, regional musculoskeletal pain, widespread musculoskeletal pain, stress, fibromyalgia syndrome, cortisol awakening response
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-65009 (URN)10.1016/j.psyneuen.2011.06.014 (DOI)000299979800014 ()
Funder
Swedish Research CouncilFAS, Swedish Council for Working Life and Social Research
Note
This research was supported by grants to Professor Ulf Lundberg from the Swedish Research Council and the Swedish Council for Working Life and Social Research. This study was also supported by the Centre for Musculoskeletal Research at the University of Gävle. Thanks to Associate Professor Petra Lindfors for her comments on the preliminary manuscript, Professor Magne Rø, MD, and Dr Tonje Okkenhaug Johansen, MD, for performing the clinical examinations on the participants, Mrs Ann-Christine Sjöbeck for performing the cortisol assays, and to Mr Håvard Wuttudal Lorås for assisting during data collection.Available from: 2011-11-30 Created: 2011-11-30 Last updated: 2017-12-08Bibliographically approved
2. Catecholamines and heart rate in female fibromyalgia patients
Open this publication in new window or tab >>Catecholamines and heart rate in female fibromyalgia patients
Show others...
2012 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 72, no 1, 51-57 p.Article in journal (Refereed) Published
Abstract [en]

Background: Fibromyalgia syndrome is a disease of unknown pathogenesis characterised by widespread chronic musculoskeletal pain. Fibromyalgia has been associated with dysregulation of the stress systems, but results are inconsistent.

Purpose: To investigate autonomic nervous system activity (urinary noradrenaline, adrenaline, dopamine, and heart rate) of fibromyalgia patients and healthy controls.

Methods: Urinary catecholamines and heart rate were assessed for a 24-hour period in a controlled hospital setting (including relaxation, a test with prolonged mental stress, and sleep), and during daily activity in 29 female fibromyalgia patients and 29 age-matched female healthy controls.

Results: With repeated measures ANOVAs, catecholamine levels were lower in patients than controls (P = .035 for noradrenaline; P = .005 for adrenaline; P = .001 for dopamine). One-way ANOVAs for the single periods showed that patients compared to controls had significantly lower adrenaline levels during the night (P = .010) and the second day (P = .010), significantly lower dopamine levels during the first day (P = .008), the night (P = .001), and the second day (P = .004). However, single time point noradrenaline levels were not significantly different between the groups. Overall, heart rate was significantly higher in patients than controls (P = .014). Specifically, significant differences emerged during relaxation (P = .016) and sleep (P = .011), but not during stress provocation or daily activities.

Conclusions: The results indicate an altered regulation of the autonomic nervous system in fibromyalgia patients, with attenuated activity of both the sympathetic (adrenal medulla component) and the parasympathetic branch.

Place, publisher, year, edition, pages
Elsevier, 2012
Keyword
chronic musculoskeletal pain, stress, noradrenaline, adrenaline, dopamine, autonomic imbalance
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-65010 (URN)10.1016/j.jpsychores.2011.09.010 (DOI)000298936400011 ()
Note
This research was supported by grants to Professor Ulf Lundberg from the Swedish Research Council and the Swedish Council for Working Life and Social Research. Support was also obtained from the Centre for Musculoskeletal Research at the University of Gävle. Thanks to Associate Professor Petra Lindfors for her comments on the preliminary manuscript, to Eva Kosek, MD, for her comments on the preliminary data, to Mrs Ann-Christine Sjöbeck for performing the catecholamine analysis, and to Mr Håvard Wuttudal Lorås for assisting during data collection.Available from: 2011-11-30 Created: 2011-11-30 Last updated: 2017-12-08Bibliographically approved
3. Fibromyalgia syndrome is associated with hypocortisolism
Open this publication in new window or tab >>Fibromyalgia syndrome is associated with hypocortisolism
Show others...
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).

Keyword
Chronic musculoskeletal pain, stress, salivary cortisol, psychosomatic symptoms
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-65003 (URN)10.1007/s12529-010-9097-6 (DOI)
Available from: 2011-11-30 Created: 2011-11-30 Last updated: 2017-12-08Bibliographically approved

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