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Fibromyalgia Syndrome is Associated with Hypocortisolism

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Abstract

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 min 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.

Conclusion

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).

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Acknowledgments

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.

Thanks to Associate Professor Petra Lindfors for her suggestions regarding the statistical analysis and for her comments on the preliminary manuscript, Mrs. Ann-Christine Sjöbeck for performing the cortisol assays, Mr. Jens Nilsson for performing the sleep analysis, and to Mr. Håvard Wuttudal Lorås for assisting during data collection.

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Authors and Affiliations

  1. Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden

    Roberto Riva

  2. Human Movement Science Programme, Norwegian University of Science and Technology, Trondheim, Norway

    Paul Jarle Mork

  3. Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway

    Rolf Harald Westgaard

  4. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway

    Magne Rø

  5. Department of Psychology, Stockholm University, Stockholm, Sweden

    Ulf Lundberg

  6. CHESS (Centre for Health Equity Studies), Stockholm University, Stockholm, Sweden

    Ulf Lundberg

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  1. Roberto Riva
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  2. Paul Jarle Mork
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  5. Ulf Lundberg
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Correspondence to Roberto Riva.

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Riva, R., Mork, P.J., Westgaard, R.H. et al. Fibromyalgia Syndrome is Associated with Hypocortisolism. Int.J. Behav. Med. 17, 223–233 (2010). https://doi.org/10.1007/s12529-010-9097-6

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