Rheumatology Medical News about fibromyalgia syndrome; management; psychoneuroendocrine perspective

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A psychoneuroendocrine perspective on the management of fibromyalgia syndrome
Journal of Musculoskeletal Pain , 04/22/09

Geenen R et al. - Tailored management of fibromyalgia syndrome FMS includes patient education, pharmacological interventions with analgesics and antidepressants, cognitive-behavioral therapy, sleep hygiene training, and low-intensity physical exercise training. This review suggests that favorable neuroendocrine changes are to be expected as part of a successful outcome of these therapeutic strategies.

Methods

Aims of this study were to:
- summarize neuroendocrine findings in FMS
- discuss how neuroendocrine functioning interacts with pain and psychological factors, and
- confer implications of this inquiry for the management of FMS

Results

With respect to hypothalamic-pituitary-adrenal axis functioning the findings were:
- normal cortisol levels
- reduced corticotrophin responses to multiple stressors
- an exaggerated corticotrophin response to exogenous corticotrophin-releasing hormone (CRH)
This may reflect a hypoactive status of CRH neurons and, as a consequence, upregulation of pituitary CRH receptors
Studies of autonomic nervous system functioning show a hyporesponsiveness to a variety of stressors
The reviewed findings suggest that neuroendocrine dysregulation is a consequence of current pain, psychological stress and distress, sleep disturbance, inactivity, and low fitness

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