Neurohumoral Profiles and Childhood Adversity of Patients with Multisomatoform Disorder and Pain as the Leading Bodily Symptom

Abstract

Objective. Patients suffering from chronic pain often present with multifactorial underlying conditions, sometimes without concrete pathological physical findings. Functional somatic syndromes (FSS) and somatoform disorders show a high prevalence of 8-20% and are often associated with adverse childhood experiences (ACE) and chronic stress. As many different FSS have overlapping symptoms, the concept of multisomatoform disorder (MSD) has been introduced as an encompassing concept. We hypothesize that a common neurohumoral profile is present in patients with MSD that is distinct from gender- and age-matched controls and thus provides insight into possible common underlying mechanisms. Design. In 151 patients with MSD (138 females) and 149 matched controls (131 females), we determined ACE by the Childhood Trauma Questionnaire (CTQ) and chronic stress by the Trier Inventory for Chronic Stress (TICS). Furthermore, the serum levels of leptin, FSH, LH, cortisol, DHEA-S, and IGF-1 have been assessed. Results. There were significant differences in the levels of leptin, FSH, IGF-1, and cortisol between patients and controls, mainly driven by female participants. Levels of leptin were significantly correlated with BMI in patients, in controls, and in the female subgroup. This correlation was exaggerated in female patients when compared to female controls. Both CTQ and TICS predicted MSD directly and indirectly through the levels of leptin. Conclusion. There is evidence of a distinct neurohumoral profile in female patients with MSD when compared to matched healthy controls, similar to what has been demonstrated in other chronic pain states. The observed profile can be taken as possible evidence for a dysregulated response to chronic stress and metabolic balance as well as a state of hypocortisolism and HPA-axis dysfunction. ACE and chronic stress play a major role in the development of MSD and altered neurohumoral profile.

Hair cortisol and self-perceived stress in adolescents with multi-system functional somatic disorders

“…However, a few studies applying short-term cortisol measures do exist, including a recent case–control study on 151 adult mainly female patients with multi-system FSD. This study found reduced levels of serum cortisol and a negative correlation between cumulative chronic stress scores and serum cortisol in females, thus providing preliminary support for the involvement of chronic stress and hypocortisolism in multi-system FSD [ 53 ]. Alternatively, the heterogeneous results of existing studies investigating HPA axis dynamics in FSD could suggest that the primary phenomenon involves a dysregulated pattern of hormone secretion, resulting in an attenuated diurnal variation of cortisol and a reduced responsiveness of the HPA axis but limited deviations in long-term cortisol levels as reflected in HCC [ 13 , 15 , 17 ].…”

Associations between chronic widespread pain, pressure pain thresholds, leptin, and metabolic factors in individuals with knee pain

“…Other studies have reported increased leptin levels in migraine [ 49 ], pelvic pain in endometriosis [ 50 ], lipedema [ 27 ], low back pain [ 51 ], and multisomatoform disorder (MSD) [ 52 ]. Leptin levels have been reported to be reduced when weight is lost [ 53 ].…”

What is the association between childhood adversity and subsequent chronic pain in adulthood? A systematic review

“…Understanding the potential for a history of adversity in people with chronic pain is an opportunity to consider management options. 31 , 36 , 48 Further research into how this information is obtained should be undertaken to allow for consistency of approach. A history of childhood adversity should be considered in the assessment of chronic pain so that relevant management options can be determined (although further research into effective interventions is also required).…”