In fact, FM is the only pain syndrome that incorporates cognitive changes into its diagnostic criteria. However, some researchers argue that this is a protective mechanism because a low cortisol level may reduce allostatic load or enhance the body’s defense system against chronic inflammation 16.Ĭognitive problems, a core symptom of FM, were reported in more than 76% of patients with FM 2, majorly involving memory, executive, and language domains 17. Based on the association between hypocortisolism and fatigue experience in CFS, the altered cortisol levels in FM might be considered a maladaptive response to stress 15. Similar to FM, an animal study 12 demonstrated chronic stress induced a hypoactive pattern of cortisol through enhanced negative feedback 13, whereas childhood maltreatment (chronic stress) was associated with higher cortisol levels in patients with FM in the afternoon 14. These inconsistent results of cortisol levels in FM might be because of different methods of measurement and the lack of a gold standard 11. In FM, however, the basal cortisol level and their diurnal change tended to be lower but inconsistent across studies 8, 9, 10, as discussed in a recent meta-analysis 11. A lower cortisol level has been reported in many stress-related disorders such as PTSD 7 and chronic fatigue syndrome (CFS). The most studied physiological system of stress is the hypothalamic–pituitary–adrenal axis and its downstream product cortisol 6. Therefore, FM may be regarded as a stress disorder 2, and stress may be a window into a thorough understanding of this elusive disorder. The disabling pain per se and complex comorbidities in FM (psychiatric and several others including migraine, irritable bowel syndrome, bladder hyperactivity, and restless leg syndrome) tremendously affect the quality of life of patients 5. In fact, patients with FM reported a higher proportion of early life adversities such as physical and sexual abuse 3 moreover, post-traumatic stress syndrome (PTSD) is a well-identified comorbidity of FM 4. Many patients with FM identified stress or a stressful event during their lifetime as a pivotal trigger for their chronic pain. Although a complex interaction between genetic disposition and environmental factors may cause FM, its pathophysiology remains undetermined 2. Future studies are warranted to elucidate whether stress management improves cognitive performance in patients with FM.įibromyalgia (FM) is a chronic pain disorder characterized by widespread body pain and several associated symptoms such as fatigue, cognitive problems, unrefreshed sleep, and depression 1. We suggested the altered cognitive function in FM may be linked to stress maladaptation. Moreover, moderate positive correlations existed between the Chinese Version Verbal Learning Test, Boston Naming Test and the morning cortisol levels within the FM group. The diurnal cortisol levels of patients with FM tended to be lower, especially at 30 min after awakening and bedtime. The FM group had more subjective cognitive complaints and performed poorer in objective cognitive testing in memory (delayed recall in Chinese Version Verbal Learning Test and Taylor Complex Figure Test), language (Boston Naming Test), and executive domains (Wisconsin Card Sorting Test) after adjustments for education. All measurements were compared between the groups and evaluated for clinical correlation. Consecutive 44 patients with FM and 48 healthy controls were enrolled for the assessments of subjective and objective cognitive functions and diurnal levels of salivary cortisol (sampled at awakening, 30 min after awakening, 3 pm, and bedtime).
This study characterized cognitive dysfunction in patients with FM and explored whether these changes are linked to altered cortisol levels.
#Sigmaplot version 12.3 windows
#Sigmaplot version 12.3 software
Software Scientific / Engineering Software
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