Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents

作者：John McBeth, Yee Ho Chiu, Alan J. Silman, David Ray, Richard Keith Morriss, Chris M Dickens, Anindya Gupta, Gary John Macfarlane · 发表于：Arthritis Research & Therapy · 年份：2005 · DOI：10.1186/ar1772 · 被引用次数：192 · 研究领域：Fibromyalgia and Chronic Fatigue Syndrome Research、Stress Responses and Cortisol、Health, psychology, and well-being

In clinic studies, altered hypothalamic-pituitary-adrenal (HPA) axis function has been associated with fibromyalgia, a syndrome characterised by chronic widespread body pain. These results may be explained by the associated high rates of psychological distress and somatisation. We address the hypothesis that the latter, rather than the pain, might explain the HPA results. A population study ascertained pain and psychological status in subjects aged 25 to 65 years. Random samples were selected from the following three groups: satisfying criteria for chronic widespread pain; free of chronic widespread pain but with strong evidence of somatisation ('at risk'); and a reference group. HPA axis function was assessed from measuring early morning and evening salivary cortisol levels, and serum cortisol after physical (pain pressure threshold exam) and chemical (overnight 0.25 mg dexamethasone suppression test) stressors. The relationship between HPA function with pain and the various psychosocial scales assessed was modelled using appropriate regression analyses, adjusted for age and gender. In all 131 persons with chronic widespread pain (participation rate 74%), 267 'at risk' (58%) and 56 controls (70%) were studied. Those in the chronic widespread pain and 'at risk' groups were, respectively, 3.1 (95% CI (1.3, 7.3)) and 1.8 (0.8, 4.0) times more likely to have a saliva cortisol score in the lowest third. None of the psychosocial factors measured were, however, associated with sali...