Cortisol Awakening Response in Patients with Shoulder and Neck Pain or Fibromyalgia

Two musculoskeletal conditions—shoulder and neck pain (SNP) and fibromyalgia syndrome (FMS)—both have an unknown pathogenesis.  They also both share some common features in regards to altered neuroendocrine responses, pain, and stress perception.

A difference between these musculoskeletal conditions is that SNP pain is localized, and FMS pain is more widespread (widespread pain is one of its hallmarks).  However, localized musculoskeletal pain may be a precursor of more widespread musculoskeletal pain.

Therefore, researchers wanted to study the cortisol awakening response (CAR) in women with SNP and in women with FMS.  They were investigating if SNP is related to a deviant regulation of the hypothalamic-pituitary-adrenal (HPA) axis.

They will publish their study in the February 2012 issue of Psychoneuroendocinology; it was published online July 18, 2011.  The article is called “Comparison of the cortisol awakening response in women with shoulder and neck pain and women with fibromyalgia.”

In the study, there were 18 women with SNP, 29 women with FMS, and 27 women who were the healthy controls (HC).  The researchers collected cortisol samples just upon awakening; samples were then also collected at 30 min and 60 min later.

Participants answered questionnaires that measured pain levels, sleeping problems, perceived stress, and psychological characteristics.

The results shows that compared with HC, women with SNP had a tendency to have higher cortisol levels; women with FMS had lower cortisol levels.  Adjusting for potential confounders did not influence the results.

It was seen that women with SNP or FMS spoke of more health complaints, pain, and perceived stress than the HC.  Women with SNP were less affected than the women with FMS.

Also, those patients with SNP showed a tendency to have elevated HPA axis activity when compared with HC.

The researchers conclude that their findings may show that hypercortisolism in regional (localized) musculoskeletal pain could be an intermediate stage on the continuum of developing hypocortisolism in widespread musculoskeletal pain.