Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Heidelberg, Germany.
Pain. 2023 Jul 1;164(7):1416-1427. doi: 10.1097/j.pain.0000000000002857. Epub 2023 Jan 5.
Evidence suggests an involvement of hypothalamic-pituitary-adrenal (HPA) axis dysregulation in the development and maintenance of fibromyalgia syndrome (FMS). However, studies on the stress response via the HPA-axis in individuals with FMS show conflicting results. To better understand the relationship between FMS and HPA-axis dysregulation, we (1) systematically summarized the current level of evidence on HPA biomarkers in individuals with FMS compared with individuals without and (2) evaluated whether FMS is associated with a specific pattern of HPA dysregulation. The main outcome measures were cortisol, adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), epinephrine, and norepinephrine. A systematic search of MEDLINE, EMBASE, and PsychMed yielded 47 studies eligible for meta-analysis, including 1465 individuals with FMS and 1192 FMS-free controls. No main effect of FMS was found on altered levels of blood cortisol, ACTH, CRH, and epinephrine. Compared with controls, salivary and urinary cortisol levels were decreased in individuals with FMS, whereas blood levels of norepinephrine were increased. However, heterogeneity of data was high with significant evidence for publication bias. Overall, the data are compatible with association of FMS with adrenocortical hypofunction in the presence of increased sympathetic tone. However, the data are partially contradictory, so it must be assumed that the data are highly dependent on the respective study designs, patient samples, and analytical methods and do not necessarily demonstrate an abnormal HPA-axis function in FMS.
有证据表明，下丘脑-垂体-肾上腺（HPA）轴的失调参与了纤维肌痛综合征（FMS）的发展和维持。然而，关于 FMS 个体的 HPA 轴应激反应的研究结果却存在矛盾。为了更好地理解 FMS 和 HPA 轴失调之间的关系，我们 (1) 系统地总结了目前关于 FMS 个体与无 FMS 个体的 HPA 生物标志物的证据水平，以及 (2) 评估了 FMS 是否与 HPA 失调的特定模式相关。主要的结局指标是皮质醇、促肾上腺皮质激素 (ACTH)、促肾上腺皮质释放激素 (CRH)、肾上腺素和去甲肾上腺素。对 MEDLINE、EMBASE 和 PsychMed 进行了系统检索，共纳入 47 项符合荟萃分析条件的研究，包括 1465 名 FMS 患者和 1192 名无 FMS 对照者。FMS 对血液皮质醇、ACTH、CRH 和肾上腺素水平的改变没有主要影响。与对照组相比，FMS 个体的唾液和尿液皮质醇水平降低，而血液去甲肾上腺素水平升高。然而，数据的异质性很高，存在明显的发表偏倚证据。总的来说，这些数据与 FMS 与肾上腺皮质功能减退伴交感神经张力增加有关。然而，这些数据存在部分矛盾，因此必须假设这些数据高度依赖于各自的研究设计、患者样本和分析方法，并不一定表明 FMS 存在异常的 HPA 轴功能。
