title: Cerebrospinal fluid corticotropin-releasing factor concentration is associated with pain but not fatigue symptoms in patients with fibromyalgia.
abstract: Previous studies have identified stress system dysregulation in fibromyalgia (FM) patients; such dysregulation may be involved in the generation and/or maintenance of pain and other symptoms. Corticotropin-releasing factor (CRF) is the principal known central nervous system mediator of the stress response; however, to date no studies have examined cerebrospinal fluid (CSF) CRF levels in patients with FM. The relationship between CSF CRF level, heart rate variability (HRV), and pain, fatigue, and depressive symptoms was examined in patients with FM. Among participants (n=26), CSF CRF levels were associated with sensory pain symptoms (r=0.574, p=0.003) and affective pain symptoms (r=0.497, p=0.011), but not fatigue symptoms. Increased HRV was also strongly associated with increased CSF CRF and FM pain. In multivariate analyses adjusting for age, sex, and depressive symptoms, the association between CSF CRF and sensory pain symptoms (t=2.54, p=0.027) persisted. Women with FM who reported a history of physical or sexual abuse had lower CSF CRF levels than women who did not report such a history. CSF CRF levels are associated with both pain symptoms and variation in autonomic function in FM. Differences in CSF CRF levels among women with and without a self-reported history of physical or sexual abuse suggest that subgroups of FM patients may exist with different neurobiological characteristics. Further studies are needed to better understand the nature of the association between CSF CRF and pain symptoms in FM.
authors.affiliation: Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA. samclean@umich.edu
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
authors.forename: David A
authors.initials: DA
authors.lastname: Williams
authors.forename: Phyllis K
authors.initials: PK
authors.lastname: Stein
authors.forename: Richard E
authors.initials: RE
authors.lastname: Harris
authors.forename: Angela K
authors.initials: AK
authors.lastname: Lyden
authors.forename: Gail
authors.initials: G
authors.lastname: Whalen
authors.forename: Karen M
authors.initials: KM
authors.lastname: Park
authors.forename: Israel
authors.initials: I
authors.lastname: Liberzon
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
authors.forename: Richard H
authors.initials: RH
authors.lastname: Gracely
authors.forename: James N
authors.initials: JN
authors.lastname: Baraniuk
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
mesh_terms: D000305:Adrenal Cortex Hormones / Q000378:metabolism; D000328:Adult; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D003346:Corticotropin-Releasing Hormone / Q000134:cerebrospinal fluid*; D003866:Depressive Disorder / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D015673:Fatigue Syndrome, Chronic / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D005356:Fibromyalgia / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000503:physiopathology; D010147:Pain Measurement; D010913:Pituitary-Adrenal System / Q000378:metabolism / Q000503:physiopathology; D011237:Predictive Value of Tests; D012737:Sex Factors; D012742:Sex Offenses / Q000523:psychology; D013315:Stress, Psychological / Q000134:cerebrospinal fluid / Q000150:complications / Q000503:physiopathology
chemical_list: D000305:Adrenal Cortex Hormones; D003346:Corticotropin-Releasing Hormone