A Psychoneuroendocrine Perspective on the Management of Fibromyalgia Syndrome

Abstract

Objectives: Pain is a multifaceted phenomenon. Next to and in interaction with aberrations in central pain processes, behavioral factors and the neuroendocrine regulation system are also involved in pain. Our aim is to summarize neuroendocrine findings in fibromyalgia syndrome [FMS], to discuss how neuroendocrine functioning interacts with pain and psychological factors, and to confer implications of this inquiry for the management of FMS.Findings: With respect to hypothalamic-pituitary-adrenal axis functioning, on average, normal cortisol levels, reduced corticotrophin responses to multiple stressors, and an exaggerated corticotrophin response to exogenous corticotrophin-releasing hormone [CRH] are found. This may reflect a hypoactive status of CRH neurons and, as a consequence, upregulation of pituitary CRH receptors. Studies of autonomic nervous system functioning show a hyporesponsiveness to a variety of stressors and indicate a persistent hyperactive sympathetic nervous system. Although a causal role of constitutional or acquired neuroendocrine dysregulation in FMS is not refuted, the reviewed findings suggest that neuroendocrine dysregulation is a consequence of current pain, psychological stress and distress, sleep disturbance, inactivity, and low fitness.Conclusions: Essential aims in the tailored management of FMS are enhancement of functional capacity and quality of life, and symptomatic treatment of individual symptoms such as pain, distress, and sleep disturbances. Patient education, pharmacological interventions with analgesics and antidepressants, cognitive-behavioral therapy, sleep hygiene training, and low-intensity physical

Deviations in the endocrine system and brain of patients with fibromyalgia: cause or consequence of pain and associated features?

“…Alterations in HPA functioning in fibromyalgia appear to be opposite to those seen in depression. In depression, endogenous CRH hypersecretion and blunted corticotrophin responses to exogenous CRH have been shown, while in fibromyalgia CRH hyposecretion and exaggerated corticotrophin responses to exogenous CRH were observed 7 …”

“…Although it is possible that neuroendocrine dysregulations reflect an impairment that is constitutional or acquired due to having been exposed to trauma in the past, we recently argued that it is also possible that disturbed neuroendocrine stress responsiveness is an epiphenomenon, that is, the consequence of physiological correlates of pain, psychological distress, sleep disturbance, inactivity, and low fitness 7 …”

“…Elevated heart rate levels in patients with medically unexplained symptoms as compared to healthy controls have been suggested to be explained by differences in sports behavior 60 . The combination of elevated tonic sympathetic nervous system levels and a hyporeactive ANS response has been found consistently in persons with low physical fitness 7 and this state of the ANS may improve after exercise training 61 …”

The Impact of Emotion-Related Autonomic Nervous System Responsiveness on Pain Sensitivity in Female Patients With Fibromyalgia

“…According to general adaptation syndrome theory, after being hyperreactive initially, the ANS may become hyporesponsive after prolonged stress exposure, such as with chronic pain (26). In support of this hyporesponsiveness hypothesis, studies of the chronic condition fibromyalgia have observed a hyporeactive ANS response to a range of physical stressors, including vasoconstrictor responses to cold pressor, norepinephrine and heart rate (HR) responses to exhausting physical exercise, ANS responses to orthostatic stress, and epinephrine responses to induced hypoglycemia (27). Much less is known, however, about ANS responses to psychosocial stressors in people with fibromyalgia (24,28,29).…”

Effects of anger and anger regulation styles on pain in daily life of women with fibromyalgia: A diary study

“…Fibromyalgia is characterized by an amplified pain response to various physical stimuli, including pressure and temperature (McDermid et al, 1996;Berglund et al, 2002). Through various biological and behavioural mechanisms (Greenwood et al, 2003), patients with fibromyalgia may also show an increase of pain in response to emotions (Keefe et al, 2001;Zautra et al, 2001;Turk and Okifuji, 2002;Staud et al, 2004;Geenen et al, 2009). Anger may be particularly harmful in chronic pain.…”