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

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. Conclusion. Among a group of psychologically at-risk subjects, dysfunction of the HPA axis helps to distinguish those who will and will not develop newonset CWP.6%Chronic widespread pain (CWP) affecting the musculoskeletal system, the principal symptom of fibromyalgia, is common, with a 1-month population prevalence of ϳ11% (1). It is associated with loss of function and considerable disability, may be associated with increased mortality rates (2), and is a major cause of health care utilization both in primary and secondary care settings. We have previously demonstrated in the prospective Altrincham Pain Study conducted in northwest England (3) that an increased risk of CWP onset is predicted from high levels of psychological distress, other somatic symptoms, and abnormal illness behavior. These factors are indicative of the process of somatization that can be defined as the tendency to express psychological distress as physical symptoms. These results confirmed for the first time that psychosocial factors preceded the onset of CWP, rather than just

The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study

“…Furthermore, dysfunctions of the hypothalamicpituitary-adrenal axis may represent a link between emotional distress and the persistence of pain. 34 Although emotional distress during pregnancy affected the recovery process of PGS in our study, the level of pain severity in pregnancy was the most important prognostic factor. High pain intensity and a high number of pain sites during pregnancy and the postpartum period may cause central sensitisation, 35 and increase the risk of persistent pain.…”

Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes

“…Nevertheless, participants who remained classified as frail or intermediately frail when adding persistent pain to the model had greater risk of adverse outcomes, suggesting that persistent pain captures some meaningful aspects of risk unexplained by other frailty indicators or covariates. Previous studies suggest that persistent pain and other frailty indicators may be signs of dysfunction in the hypothalamic-pituitary-adrenal axis and stress response (23,24), which are widely associated with poor mental and physical health outcomes (25)(26)(27)(28). Alternatively, persistent pain may represent a critical level of dysregulation severity, leading to age-related changes in pain Notes: ADL = activities of daily living; CESD = Centers for Epidemiologic Studies Depression; CI = confidence interval; HR = hazard ratio; IADL = instrumental activities of daily living.…”

Racial Discrimination and Racial Identity Attitudes in Relation to Self-Rated Health and Physical Pain and Impairment Among Two-Spirit American Indians/Alaska Natives

“…68 For example, stressful events may manifest in pain by disrupting normal functioning of the neuroendocrine hypothalamic-pituitary-adrenal stress axis, which has been implicated in common forms of inflammatory and neuropathic pain. 40,[69][70][71] Psychosocial stressors may also adversely affect physical health through other biological mechanisms [43][44][45][46] or through their association with maladaptive health behaviors. [22][23][24][25] Our results on pain and impairment are consistent with previous studies linking discrimination and physical health outcomes; they also suggest that actualization may be protective, possibly by helping to regulate biological mechanisms involved in physical pain and impairment.…”