ORIGINAL ARTICLE
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Morning and evening salivary cortisol levels in patients with chronic widespread pain and those at high risk
Nayab Begum,
Jason R Taylor,
Christopher Brown,
Jonathan Rajan,
Brian Keevil,
Emily Pye,
Timothy Rainey,
Anthony Jones,
Corresponding Author
Nayab Begum
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Correspondence:
Nayab Begum, Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester M6 8HD, UK.
Email: [email protected]
Search for more papers by this authorJason R Taylor
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorChristopher Brown
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Department of Psychological Sciences, University of Liverpool, Liverpool, UK
Search for more papers by this authorJonathan Rajan
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorBrian Keevil
Department of Clinical Biochemistry, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
Search for more papers by this authorEmily Pye
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorTimothy Rainey
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorAnthony Jones
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorNayab Begum,
Jason R Taylor,
Christopher Brown,
Jonathan Rajan,
Brian Keevil,
Emily Pye,
Timothy Rainey,
Anthony Jones,
Corresponding Author
Nayab Begum
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Correspondence:
Nayab Begum, Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester M6 8HD, UK.
Email: [email protected]
Search for more papers by this authorJason R Taylor
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorChristopher Brown
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Department of Psychological Sciences, University of Liverpool, Liverpool, UK
Search for more papers by this authorJonathan Rajan
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorBrian Keevil
Department of Clinical Biochemistry, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
Search for more papers by this authorEmily Pye
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorTimothy Rainey
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorAnthony Jones
Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
Search for more papers by this authorFunding information
The study was funded by the University of Manchester.
Abstract
Background
Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation has been implicated in chronic widespread pain (CWP); the hallmark of fibromyalgia (FM). This is the first study to compare HPA axis changes in individuals with CWP and those at high risk of symptom development.
Methods
We sought to determine differences in morning and evening salivary cortisol levels in FM (n = 19), those at-risk (n = 20) and pain-free controls (n = 17). Risk factors included non-CWP pain, somatic symptoms, illness behaviour and sleep disturbance. We conducted the study in the absence of centrally acting medication, to address limitations of previous research.
Results
Repeated measures ANOVA revealed significant main effects of group (p = 0.003), and time of day (p = 0.002), with no significant interaction. Cortisol levels were higher in FM (p = 0.027) and at-risk (p = 0.003) groups, compared to controls, but there was no significant difference between FM and at-risk groups. The main effect of group remained significant with sleep problems (p = 0.021) and life events (p = 0.007), but was not significant with anxiety (p = 0.076) or depression (p = 0.098) scores as covariates. With sleep problems as a covariate, cortisol levels remained significantly higher only in the at-risk group (p = 0.017).
Conclusions
This study indicates elevated salivary cortisol in FM and those at high risk, and identifies anxiety, depression and sleep problems as potential contributing factors. The results shed light on the dynamic relationship between stress, mood and sleep disorders and the brain's resilience to pain.
Significance
This study examines neurobiological changes in chronic widespread pain and high risk individuals. One strength of the study is the absence of centrally acting medication. We found high salivary cortisol common to Fibromyalgia and those at risk and identified contributing factors. Our results offer insight into the early mechanistic changes underlying Fibromyalgia development and open up possibilities for early diagnosis and prevention.
CONFLICTS OF INTEREST
There are no conflicts to report.
Supporting Information
| Filename | Description |
|---|---|
| ejp1854-sup-0001-FigS1.docxWord 2007 document , 51.6 KB | Figure S1 |
| ejp1854-sup-0002-TableS1.docxWord 2007 document , 12.7 KB | Table S1 |
| ejp1854-sup-0003-MethodsS1.docxWord 2007 document , 15 KB | Methods S1 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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