Table 1.

Element of HPA axis	Abnormalities observed in fibromyalgia
ACTH	Hyperactive ACTH response to CRH
Cortisol	Hypercortisolemia: high basal total plasma cortisol
Cortisol	Hypocortisolemia: low basal total plasma cortisol, low 24 h urinary-free cortisol levels and low peak serum cortisol levels
GC receptors	GC feedback resistance

The Hypothalamic–Pituitary–Adrenal Axis has Been Observed to be Dysfunctional at Many Levels of the System in Fibromyalgia.

ACTH: Adrenocorticotrophic hormone; CRH: Corticotrophin-releasing hormone; GC: Glucocorticoid; HPA: Hypothalamic-pituitary-adrenal
Data taken from [14-16].

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Authors

Angeline S. Thiagarajah, BMedSc(Hons)

Department of Medicine, Monash University and Monash Health, Melbourne, Australia

Disclosures

Disclosure: Angeline S. Thiagarajah, BMedSc(Hons), has disclosed no relevant financial relationships.

Emma K. Guymer, MBBS, FRACP

Departments of Medicine and Rheumatology, Monash University and Monash Health, Melbourne, Australia

Disclosures

Disclosure: Emma K. Guymer, MBBS, FRACP, has disclosed no relevant financial relationships.

Michelle Leech, MBBS, PhD, FRACP

Departments of Medicine and Rheumatology, Monash University and Monash Health, Melbourne, Australia

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Disclosure: Michelle Leech, MBBS, PhD, FRACP, has disclosed no relevant financial relationships.

Geoffrey O. Littlejohn, MBBS (Hons), MD, MPH, FRACP, FRCP (Edin)

Departments of Medicine and Rheumatology, Monash University and Monash Health, Melbourne, Australia

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Disclosure: Geoffrey O. Littlejohn, MBBS (Hons), MD, MPH, FRACP, FRCP (Edin), has disclosed no relevant financial relationships.

Editor

Laura Dormer

Editor, Future Science Group, London, United Kingdom

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Charles P. Vega, MD

Clinical Professor of Family Medicine, University of California, Irvine

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Disclosure: Charles P. Vega, MD, has disclosed the following financial relationships:
Served as an advisor or consultant for: McNeil Pharmaceuticals

CME Reviewer

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

CME

The Relationship Between Fibromyalgia, Stress and Depression

Authors: Angeline S. Thiagarajah, BMedSc(Hons); Emma K. Guymer, MBBS, FRACP; Michelle Leech, MBBS, PhD, FRACP; Geoffrey O. Littlejohn, MBBS (Hons), MD, MPH, FRACP, FRCP (Edin)
CME Released: 10/17/2014
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 10/17/2015

Start Activity

Target Audience and Goal Statement

This activity is intended for primary care physicians, rheumatologists, psychiatrists, pain management specialists, and other physicians who care for patients with fibromyalgia, stress, and depression.

The goal of this activity is to evaluate the relationships between stress, depression, and fibromyalgia.

Upon completion of this activity, participants will be able to:

Distinguish events that might promote fibromyalgia
Analyze psychological traits associated with the diagnosis of fibromyalgia
Assess the effects of stress, fibromyalgia, and depression on the hypothalamic-pituitary-adrenal axis
Evaluate the relationship between depression and fibromyalgia

Disclosures

Authors

Angeline S. Thiagarajah, BMedSc(Hons)

Department of Medicine, Monash University and Monash Health, Melbourne, Australia

Disclosures

Disclosure: Angeline S. Thiagarajah, BMedSc(Hons), has disclosed no relevant financial relationships.

Emma K. Guymer, MBBS, FRACP

Departments of Medicine and Rheumatology, Monash University and Monash Health, Melbourne, Australia

Disclosures

Disclosure: Emma K. Guymer, MBBS, FRACP, has disclosed no relevant financial relationships.

Michelle Leech, MBBS, PhD, FRACP

Departments of Medicine and Rheumatology, Monash University and Monash Health, Melbourne, Australia

Disclosures

Disclosure: Michelle Leech, MBBS, PhD, FRACP, has disclosed no relevant financial relationships.

Geoffrey O. Littlejohn, MBBS (Hons), MD, MPH, FRACP, FRCP (Edin)

Departments of Medicine and Rheumatology, Monash University and Monash Health, Melbourne, Australia

Disclosures

Disclosure: Geoffrey O. Littlejohn, MBBS (Hons), MD, MPH, FRACP, FRCP (Edin), has disclosed no relevant financial relationships.

Editor

Laura Dormer

Editor, Future Science Group, London, United Kingdom

Disclosures

Disclosure: Laura Dormer has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD

Clinical Professor of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed the following financial relationships:
Served as an advisor or consultant for: McNeil Pharmaceuticals

CME Reviewer

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

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From International Journal of Clinical Rheumatology

CME

The Relationship Between Fibromyalgia, Stress and Depression

Authors: Angeline S. Thiagarajah, BMedSc(Hons); Emma K. Guymer, MBBS, FRACP; Michelle Leech, MBBS, PhD, FRACP; Geoffrey O. Littlejohn, MBBS (Hons), MD, MPH, FRACP, FRCP (Edin)Faculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 10/17/2014

Valid for credit through: 10/17/2015

processing....

Abstract and Introduction

Abstract

Fibromyalgia is noted for its association with both psychological stress and depression. However, the precise nature of these relationships remains contentious, as indicated by a large body of conflicting literature. Inconsistencies regarding the nature of stress in fibromyalgia are related to the poor characterization of biological stress systems in the different presentations of fibromyalgia. Similarly, conflicting literature regarding depression and fibromyalgia is likely due to the heterogeneous nature of both fibromyalgia and depression. Emerging evidence indicates that fibromyalgia and depression are both syndromes, which affects the way in which each disorder should be considered. In this review, the nature of stress and depression in the context of fibromyalgia will be discussed.

Introduction

Fibromyalgia is a common chronic pain syndrome, which affects 2–4% of people worldwide.^[1] Women with fibromyalgia outnumber men by a ninefold factor^[2]. Chronic widespread pain (CWP) is the cardinal symptom of fibromyalgia, and associated symptoms defining the phenotype include sleep disturbance, fatigue and cognitive dysfunction. Psychological experiences of anxiety and affective dysfunction are common.^[3]

Given the abundance of psychological phenomena contained within the associated symptoms of fibromyalgia it is expected that it is commonly associated with stress. The strength of this relationship is such that fibromyalgia has been described as a 'stress-related illness'.^[3] However, in order to contextualize the importance of stress in the pathogenesis of fibromyalgia, the nature of stress must first be discussed.

Page 1 of 11

What is Stress?

CME Information

References

References

Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

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Table 1.

References

Faculty and Disclosures

Authors

Angeline S. Thiagarajah, BMedSc(Hons)

Emma K. Guymer, MBBS, FRACP

Michelle Leech, MBBS, PhD, FRACP

Geoffrey O. Littlejohn, MBBS (Hons), MD, MPH, FRACP, FRCP (Edin)

Editor

Laura Dormer

CME Author

Charles P. Vega, MD

CME Reviewer

Amy Bernard, MS, BSN, RN-BC

CME

The Relationship Between Fibromyalgia, Stress and Depression

Target Audience and Goal Statement

Disclosures

Authors

Angeline S. Thiagarajah, BMedSc(Hons)

Emma K. Guymer, MBBS, FRACP

Michelle Leech, MBBS, PhD, FRACP

Geoffrey O. Littlejohn, MBBS (Hons), MD, MPH, FRACP, FRCP (Edin)

Editor

Laura Dormer

CME Author

Charles P. Vega, MD

CME Reviewer

Amy Bernard, MS, BSN, RN-BC

Accreditation Statements

For Physicians

Instructions for Participation and Credit

The Relationship Between Fibromyalgia, Stress and Depression

Abstract and Introduction

Abstract

Introduction

Table of Contents