title: Fibromyalgia syndrome is associated with hypocortisolism.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden. roberto.riva@psychology.su.se
authors.forename: Roberto
authors.initials: R
authors.lastname: Riva
authors.forename: Paul Jarle
authors.initials: PJ
authors.lastname: Mork
authors.forename: Rolf Harald
authors.initials: RH
authors.lastname: Westgaard
authors.forename: Magne
authors.initials: M
authors.lastname: Rø
authors.forename: Ulf
authors.initials: U
authors.lastname: Lundberg
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002940:Circadian Rhythm / Q000502:physiology; D004576:Electromyography; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000502:physiology; D008875:Middle Aged; D010551:Personality / Q000502:physiology; D017286:Polysomnography; D012463:Saliva / Q000737:chemistry; D012890:Sleep / Q000502:physiology; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology; D011795:Surveys and Questionnaires
chemical_list: D006854:Hydrocortisone
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