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Although fibromyalgia syndrome (FMS) is a chronic condition, its cardinal symptom pain is known to fluctuate over the day.
Stress plays a
vital role in enhancing the pain in the women suffering from fibromyalgia
syndrome (FMS). According to this study, for the fluctuation of pain levels in
FMS patients, cortisol may be involved.
Although
fibromyalgia syndrome (FMS) is a chronic condition, its cardinal symptom pain
is known to fluctuate over the day. Stress has often been claimed to exacerbate
pain; however, there is barely any evidence on whether or not this is true on a
day-to-day basis (and, alternatively, on whether pain leads to increased stress
levels). Using an ecologically valid measurement design, we tested whether and
how stress and pain are intertwined in participants with FMS. We additionally
examined the role of the two major stress-responsive systems, the
hypothalamic-pituitary-adrenal axis and the autonomic nervous system, as
potential mediators of this relationship.
An ambulatory
assessment study was conducted over the course of 14 days. On each day, 32
females with FMS provided six diary entries on momentary stress and pain
levels. Saliva samples were collected at the same time points to determine
cortisol and alpha-amylase as indicators of stress-responsive systems.
Higher stress at
a given measurement time point was associated with higher reported pain levels
at the subsequent time point (UC = 1.47, p < 0.001), but not vice versa
(UC < 0.01, p = 0.179). The stress-pain relationship was neither mediated by
momentary cortisol nor by alpha-amylase; however, momentary cortisol was
independently associated with momentary pain (UC = 0.27, p = 0.009).
Stress seems to
be a powerful exacerbating factor for pain as experienced by patients with FMS
in their everyday lives. Cortisol may be involved in the diurnal fluctuation of
pain levels in patients with FMS. Future studies should identify relevant daily
stressors in persons with FMS and scrutinize the mechanisms underlying the
cortisol-pain relationship.
Psychoneuroendocrinology 2016 Jan; 63:68-77
Stress exacerbates pain in the everyday lives of women with fibromyalgia syndrome—The role of cortisol and alpha-amylase
Susanne Fischer et al.
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