Morning and evening salivary cortisol levels in patients with chronic widespread pain and those at high risk

Abstract

Background

Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation has been implicated in chronic widespread pain (CWP); the hallmark of fibromyalgia (FM). This is the first study to compare HPA axis changes in individuals with CWP and those at high risk of symptom development.

Methods

We sought to determine differences in morning and evening salivary cortisol levels in FM (n = 19), those at-risk (n = 20), and pain-free controls (n = 17). Risk factors included non-CWP pain, somatic symptoms, illness behaviour and sleep disturbance. We conducted the study in the absence of centrally-acting medication, to address limitations of previous research.

Results

Repeated measures ANOVA revealed significant main effects of group (p = 0.003), and time of day (p = 0.002), with no significant interaction. Cortisol levels were higher in FM (p = 0.027) and at-risk (p = 0.003) groups, compared to controls, but there was no significant difference between FM and at-risk groups. The main effect of group remained significant with sleep problems (p = 0.021), and life events (p = 0.007), but was not significant with anxiety (p = 0.076) or depression (p = 0.098) scores as covariates. With sleep problems as a covariate, cortisol levels remained significantly higher only in the at-risk group (p = 0.017).

Conclusions

This study indicates elevated salivary cortisol in FM and those at high risk, and identifies anxiety, depression, and sleep problems as potential contributing factors. The results shed light on the dynamic relationship between stress, mood and sleep disorders and the brain’s resilience to pain.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3jlv8Kf
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