Generaal Ellen, Vogelzangs Nicole, Macfarlane Gary J, Geenen Rinie, Smit Johannes H, Penninx Brenda W J H, Dekker Joost
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, PO Box 74077, 1070 BB Amsterdam, The Netherlands.
BMC Musculoskelet Disord. 2014 Jul 9;15:227. doi: 10.1186/1471-2474-15-227.
Studies on hypothalamic-pituitary-adrenal axis (HPA-axis) function amongst patients with chronic pain show equivocal results and well-controlled cohort studies are rare in this field. The goal of our study was to examine whether HPA-axis dysfunction is associated with the presence and the severity of chronic multi-site musculoskeletal pain.
Data are from the Netherlands Study of Depression and Anxiety including 1125 subjects with and without lifetime depressive and anxiety disorders. The Chronic Pain Grade questionnaire was used to determine the presence and severity of chronic multi-site musculoskeletal pain. Subjects were categorized into a chronic multi-site musculoskeletal pain group (n = 471) and a control group (n = 654). Salivary cortisol samples were collected to assess HPA-axis function (awakening level, 1-h awakening response, evening level, diurnal slope and post-dexamethasone level).
In comparison with the control group, subjects with chronic multi-site musculoskeletal pain showed significantly lower cortisol level at awakening, lower evening level and a blunted diurnal slope. Lower cortisol level at awakening and a blunted diurnal slope appeared to be restricted to those without depressive and/or anxiety disorders, who also showed a lower 1-h awakening response.
Our results suggest hypocortisolemia in chronic multi-site musculoskeletal pain. However, if chronic pain is accompanied by a depressive or anxiety disorder, typically related to hypercortisolemia, the association between cortisol levels and chronic multi-site musculoskeletal pain appears to be partly masked. Future studies should take psychopathology into account when examining HPA-axis function in chronic pain.
关于慢性疼痛患者下丘脑-垂体-肾上腺轴（HPA轴）功能的研究结果不一，且该领域中严格对照的队列研究较少。我们研究的目的是检验HPA轴功能障碍是否与慢性多部位肌肉骨骼疼痛的存在及严重程度相关。
数据来自荷兰抑郁与焦虑研究，包括1125名有或无终生抑郁和焦虑障碍的受试者。使用慢性疼痛分级问卷来确定慢性多部位肌肉骨骼疼痛的存在及严重程度。受试者被分为慢性多部位肌肉骨骼疼痛组（n = 471）和对照组（n = 654）。收集唾液皮质醇样本以评估HPA轴功能（觉醒水平、觉醒后1小时反应、夜间水平、昼夜斜率和地塞米松后水平）。
与对照组相比，慢性多部位肌肉骨骼疼痛患者在觉醒时的皮质醇水平显著较低，夜间水平较低，昼夜斜率变钝。觉醒时较低的皮质醇水平和变钝的昼夜斜率似乎仅限于那些没有抑郁和/或焦虑障碍的患者，他们的觉醒后1小时反应也较低。
我们的结果表明慢性多部位肌肉骨骼疼痛存在低皮质醇血症。然而，如果慢性疼痛伴有抑郁或焦虑障碍，通常与高皮质醇血症有关，皮质醇水平与慢性多部位肌肉骨骼疼痛之间的关联似乎会部分被掩盖。未来在研究慢性疼痛中的HPA轴功能时应考虑精神病理学因素。
