当前位置： SCI文献检索 > ARTHRITIS RESEARCH & THERAPY期刊下所有文献 > Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents.

Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents.

Abstract：

:In clinic studies, altered hypothalamic-pituitary-adrenal (HPA) axis function has been associated with fibromyalgia, a syndrome characterised by chronic widespread body pain. These results may be explained by the associated high rates of psychological distress and somatisation. We address the hypothesis that the latter, rather than the pain, might explain the HPA results. A population study ascertained pain and psychological status in subjects aged 25 to 65 years. Random samples were selected from the following three groups: satisfying criteria for chronic widespread pain; free of chronic widespread pain but with strong evidence of somatisation ('at risk'); and a reference group. HPA axis function was assessed from measuring early morning and evening salivary cortisol levels, and serum cortisol after physical (pain pressure threshold exam) and chemical (overnight 0.25 mg dexamethasone suppression test) stressors. The relationship between HPA function with pain and the various psychosocial scales assessed was modelled using appropriate regression analyses, adjusted for age and gender. In all 131 persons with chronic widespread pain (participation rate 74%), 267 'at risk' (58%) and 56 controls (70%) were studied. Those in the chronic widespread pain and 'at risk' groups were, respectively, 3.1 (95% CI (1.3, 7.3)) and 1.8 (0.8, 4.0) times more likely to have a saliva cortisol score in the lowest third. None of the psychosocial factors measured were, however, associated with saliva cortisol scores. Further, those in the chronic widespread pain (1.9 (0.8, 4.7)) and 'at risk' (1.6 (0.7, 3.6)) groups were also more likely to have the highest serum cortisol scores. High post-stress serum cortisol was related to high levels of psychological distress (p = 0.05, 95% CI (0.02, 0.08)). After adjusting for levels of psychological distress, the association between chronic widespread pain and post-stress cortisol scores remained, albeit slightly attenuated. This is the first population study to demonstrate that those with established, and those psychologically at risk of, chronic widespread pain demonstrate abnormalities of HPA axis function, which are more marked in the former group. Although some aspects of the altered function are related to the psychosocial factors measured, we conclude that the occurrence of HPA abnormality in persons with chronic widespread pain is not fully explained by the accompanying psychological stress.

journal_name

Arthritis Res Ther

journal_title

Arthritis research & therapy

authors

McBeth J,Chiu YH,Silman AJ,Ray D,Morriss R,Dickens C,Gupta A,Macfarlane GJ

doi

10.1186/ar1772

keywords:

subject

Has Abstract

pub_date

2005-01-01 00:00:00

pages

R992-R1000

issue

eissn

1478-6354

issn

1478-6362

pii

ar1772

journal_volume

pub_type

杂志文章

在线工具

Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents.