Can stress make you have more symptoms in fibromyalgia?

This study looked at the effect of stress on the shifting symptoms of fibromyalgia. Cortisol is a hormone that is released in response to stress. They had the participants keep a diary of their stress levels and pain symptoms and then measured their saliva to see if their cortisol were elevated in response to the increased stress. They found that increased stress correlated with higher levels of pain. They did not find that increased stress and pain correlated with increased cortisol levels. They did find that increased cortisol levels corresponded to increased pain. The implication of this study is that the fluctuating pain seen in fibromyalgia may be related to the daily varying levels of cortisol in our system.

Glossary:

Cortisol: hormone released from the adrenal gland in response to stress and low blood sugar

The Research

Psychoneuroendocrinology. 2016 Jan;63:68-77. doi: 10.1016/j.psyneuen.2015.09.018. Epub 2015 Sep 21.

Stress exacerbates pain in the everyday lives of women with fibromyalgia syndrome–The role of cortisol and alpha-amylase.

Fischer S¹, Doerr JM¹, Strahler J¹, Mewes R², Thieme K³, Nater UM⁴.

Author information:

 ¹Clinical Biopsychology, Department of Psychology, University of Marburg, Germany.

 ²Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Germany.

 ³Department for Medical Psychology, Medical School, University of Marburg, Germany.

 ⁴Clinical Biopsychology, Department of Psychology, University of Marburg, Germany. Electronic address: nater@uni-marburg.de.

Abstract

OBJECTIVE:

Although fibromyalgia syndrome (FMS) is a chronic condition, its cardinal symptom pain is known to fluctuate over the day. Stress has often been claimed to exacerbate pain; however, there is barely any evidence on whether or not this is true on a day-to-day basis (and, alternatively, on whether pain leads to increased stress levels). Using an ecologically valid measurement design, we tested whether and how stress and pain are intertwined in participants with FMS. We additionally examined the role of the two major stress-responsive systems, the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, as potential mediators of this relationship.

METHODS:

An ambulatory assessment study was conducted over the course of 14 days. On each day, 32 females with FMS provided six diary entries on momentary stress and pain levels. Saliva samples were collected at the same time points to determine cortisol and alpha-amylase as indicators of stress-responsive systems.

RESULTS:

Higher stress at a given measurement time point was associated with higher reported pain levels at the subsequent time point (UC=1.47, p<0.001), but not vice versa (UC<0.01, p=0.179). The stress-pain relationship was neither mediated by momentary cortisol nor by alpha-amylase; however, momentary cortisol was independently associated with momentary pain (UC=0.27, p=0.009).

CONCLUSION:

Stress seems to be a powerful exacerbating factor for pain as experienced by patients with FMS in their everyday lives. Cortisol may be involved in the diurnal fluctuation of pain levels in patients with FMS. Future studies should identify relevant daily stressors in persons with FMS and scrutinize the mechanisms underlying the cortisol-pain relationship.