Moderation of psychosocial risk factors through dysfunction of the hypothalamic–pituitary–adrenal stress axis in the onset of chronic widespread musculoskeletal pain : Findings of a population‐based prospective cohort study
Open Access
- 2 January 2007
- journal article
- research article
- Published by Wiley in Arthritis & Rheumatism
- Vol. 56 (1), 360-371
- https://doi.org/10.1002/art.22336
Abstract
Objective To test the hypothesis that abnormalities in the hypothalamic–pituitary–adrenal (HPA) stress‐response system would act as an effect moderator between HPA function and the onset of chronic widespread pain (CWP). Methods We conducted a population‐based prospective cohort study. Current pain and psychosocial status were ascertained in 11,000 subjects. Of the 768 eligible subjects free of CWP but at future risk based on their psychosocial profile, 463 were randomly selected, and 267 (57.7%) consented to assessment of their HPA axis function. Diurnal function was measured by assessing levels of salivary cortisol in the morning (9:00 AM) and evening (10:00 PM). Serum cortisol levels were measured after an overnight low‐dose (0.25 mg) dexamethasone suppression test and a potentially stressful clinical examination. All subjects were followed up 15 months later to identify cases of new‐onset CWP. Results A total of 241 subjects (94.9%) completed the followup study, and 28 (11.6%) reported the new onset of CWP. High levels of cortisol post‐dexamethasone (odds ratio [OR] 3.53, 95% confidence interval [95% CI] 1.17–10.65), low levels in morning saliva (OR 1.43, 95% CI 0.52–3.94), and high levels in evening saliva (OR 2.32, 95% CI 0.64–8.42) were all associated with CWP. These 3 factors were found to be independent and additive predictors of CWP (OR for all 3 factors 8.5, 95% CI 1.5–47.9) in analyses controlling for age, sex, depression, sleep disturbance, recent traumatic life events, and pain status. One or more of these 3 HPA factors identified 26 (92.9%) cases of new‐onset CWP. Conclusion Among a group of psychologically at‐risk subjects, dysfunction of the HPA axis helps to distinguish those who will and will not develop new‐onset CWP.Keywords
This publication has 28 references indexed in Scilit:
- Birth weight is associated with salivary cortisol responses to psychosocial stress in adult lifePsychoneuroendocrinology, 2005
- The Effects of Child Maltreatment on the Hypothalamic-Pituitary-Adrenal AxisTrauma, Violence, & Abuse, 2004
- Childhood parental loss and cortisol levels in adult menPsychoneuroendocrinology, 2004
- Widespread body pain and mortality: prospective population based study Commentary: An interesting finding, but what does itBMJ, 2001
- Neuroendocrine and hormonal perturbations and relations to the serotonergic system in fibromyalgia patientsScandinavian Journal of Rheumatology, 2000
- Hypothalamic–pituitary–adrenal axis perturbations in patients with fibromyalgiaArthritis & Rheumatism, 1994
- The american college of rheumatology 1990 criteria for the classification of fibromyalgiaArthritis & Rheumatism, 1990
- A scale for the estimation of sleep problems in clinical researchJournal of Clinical Epidemiology, 1988
- The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threatPsychological Medicine, 1985
- The Hospital Anxiety and Depression ScaleActa Psychiatrica Scandinavica, 1983