Stress Aggravates Pain in Female Patients With Fibromyalgia

Stress Aggravates Pain in Female Patients With Fibromyalgia

Researchers from the University of Marburg, Germany recently studied how stress affects women with Fibromyalgia Syndrome. The work, entitled “Stress exacerbates pain in the everyday lives of women with fibromyalgia syndrome—The role of cortisol and alpha-amylase” was recently published in the Psychoneuroendocrinology journal.

Fibromyalgia Syndrome (FMS) refers to widespread muscle pain, tenderness to palpation and incapacitating fatigue that cannot be explained by any medical conditions. FMS is a chronic disease that shows little improvement over time. Although symptoms are usually stable, there are evidences suggesting that stress can exacerbate and perpetuate FMS pain. In this work, scientists investigated the relationship between stress and pain in FMS patients without massive depression disorders. Authors also examined whether the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, two major stress-related systems, played a role in the development of this relationship.

The study consisted of a 14 day ambulatory assessment study of 32 FMS female patients between 18 and 65 years of age. Only female patients were considered due to the higher impact of FMS in women and also to avoid known discrepancies in pain evaluation between males and females. Participants provided six daily entries on momentary stress and pain levels, which were accompanied by simultaneous saliva collections to determine cortisol and alpha-amylase levels – indicatives of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, respectively. The results showed that stress is associated with a higher pain level, although the opposite is not true. The stress-pain relationship is not mediated by neither cortisol nor alpha-amylase levels. Nonetheless, the authors found a correlation between cortisol levels and pain within one hour of awakening suggesting that cortisol might contribute for the diurnal fluctuation of FMS symptoms.

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The researchers conclude that stress is an important exacerbating factor for pain in FMS patients and a potential contributor of pain perpetuating in these patients. As a caution note, authors recommend that their findings should be confirmed in broader studies that include the full FMS patient population. Nonetheless, their finding that stress aggravates pain in FMS patients is supported by others studies that already suggest stress and pain are intertwined. This conclusion highlights the significance of stress managing approaches in FMS patients and the necessity for future studies to identify and develop therapies targeting stressors – mechanisms causing stress – that contribute for pain aggravation in these patients.