Effects of a health education program on cytokines and cortisol levels in fibromyalgia patients: a randomized controlled trial

Abstract

Background: Fibromyalgia (FM) is a syndrome characterized by widespread chronic pain associated to other symptoms, such as: fatigue, anxiety, depression and sleep disorders. Health education programs (HEP) have emerged as good non-pharmacological strategies to treat it. However, it is still not clear if the benefits are only subjective, or it has also objective impacts on immune and or neuroendocrine systems. Methods: Fifty-eight fibromyalgia women were randomly allocated in experimental group (n = 27) or control group (n = 31). The experimental group was submitted to HEP treatment for 11 weeks, while control group did not receive intervention at the same period. All data were collected at zero and 11th week by a blinded researcher. The statistical analysis were made in GraphPad Prism software (version 5.0) with significant level adjusted for α = 0.05. Results: Forty-four patients concluded the full study, 21 in the experimental group and 23 in the control group. Intragroup and intergroup analysis revealed that treatment induced significant increases of IL-4 plasma levels, antiinflammatory cytokine/inflammatory cytokine ratio (AC/IC ratio), salivary cortisol levels, in addition to significant decreases on FIQ scores. Intergroup variation analyses revealed also significant increases of IL-10 plasma levels. Conclusion: The results presented suggest that this kind of HEP could induce subjective and objective changes (immune and neuroendocrine), that could explain, at least in part the improvement of fibromyalgia patient's health status. (Clinical Trial Registration Number-ReBEC-RBR-5tdnbr).

Pain and Cortisol in Patients with Fibromyalgia: Systematic Review and Meta-Analysis

“…Cortisol measurement protocols (in urine or blood) and pain tolerance or threshold tests were conducted using different instruments and protocols. This disparity might explain why Torgrimson-Ojerio et al [40] noted significant reductions in cortisol in their FM group while others report significant reductions in the control group [34]. Variation in pain was described in the study by Geiss et al, who used the pressure pain threshold method [33], while Pernambuco et al, Riva et al, and Stehlik et al, measured pain more subjectively though the fibromyalgia impact questionnaire (FIQ) and visual analogue scale (VAS), respectively [34,35,38].…”

“…Several independent studies for this review were selected according to descriptive statistics and effect sizes reported for the effects of several predictive variables on cortisol levels. In two of these studies, significant medium size effects were observed [31,38], while in three, effects were both significant and large [18,34,40].…”

“…Among these studies, significant medium effect sizes were detected in the studies of Pegado et al [31] and Stehlit et al [38] (ES = 0.017; 95%CI 0.066-1.421; p < 0.05; and ES = 0.79; 95%CI 0.189-1.365; p < 0.05, respectively). Significant large effect sizes were observed in the studies by Genc et al [18], Pernambuco et al [34], and Torgrimson-Ojerio et al [40] (ES = 0.807; 95%CI 0.230-1.384; p < 0.05; η2 = 1.630; 95%CI 0.944-2.316; p < 0.05; η2 = 0.74; 95%CI 0.418-1.055; p < 0.05, respectively). Collectively, these data indicate an overall effect of the interventions on cortisol.…”

“…This may be mainly attributed to incomplete descriptions of the exercise programs tested and poor patient adherence [47]. Physical therapy was the second most common intervention tested [30,36] and one study was based on lifestyle interventions [34]. Three of the studies involved an observational assessment [31,35,38].…”

“…Of the 10 studies reviewed, four were non-randomized controlled [30,33,35,36], two randomized controlled [18,34], two observational [31,32], one case-control [38] and one pilot study [40].…”