Stress exacerbates pain in the everyday lives of women with fibromyalgia syndrome—The role of cortisol and alpha-amylase
Abstract
Objective Although fibromyalgia syndrome (FMS) is a chronic condition, its cardinal symptom pain is known to fluctuate over the day. Stress has often been claimed to exacerbate pain; however, there is barely any evidence on whether or not this is true on a day-to-day basis (and, alternatively, on whether pain leads to increased stress levels). Using an ecologically valid measurement design, we tested whether and how stress and pain are intertwined in participants with FMS. We additionally examined the role of the two major stress-responsive systems, the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, as potential mediators of this relationship. Methods An ambulatory assessment study was conducted over the course of 14 days. On each day, 32 females with FMS provided six diary entries on momentary stress and pain levels. Saliva samples were collected at the same time points to determine cortisol and alpha-amylase as indicators of stress-responsive systems. Results Higher stress at a given measurement time point was associated with higher reported pain levels at the subsequent time point (UC=1.47, p<0.001), but not vice versa (UC<0.01, p=0.179). The stress-pain relationship was neither mediated by momentary cortisol nor by alpha-amylase; however, momentary cortisol was independently associated with momentary pain (UC=0.27, p=0.009). Conclusion Stress seems to be a powerful exacerbating factor for pain as experienced by patients with FMS in their everyday lives. Cortisol may be involved in the diurnal fluctuation of pain levels in patients with FMS. Future studies should identify relevant daily stressors in persons with FMS and scrutinize the mechanisms underlying the cortisol-pain relationship.
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Central sensitisation pathways, associated with abnormal hypothalamic-pituitary-adrenal axis responses, likely underlie the exacerbations of fibromyalgia observed during the conflict.
“Central sensitisation pathways, associated with abnormal hypothalamic–pituitary–adrenal axis responses, likely underlie these exacerbations (Beiner et al. 2024; Fischer et al. 2016).”
From Physical and Mental Health of Fibromyalgia Patients Following October 7th Attack and the Ensuing Military Conflict: A Cross-Sectional Analysis (2025) · cites this paper as Fischer et al. 2016
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- Authors
- Fischer, S., Doerr, J. M., Strahler, J., Mewes, R., Thieme, K., & Nater, U. M.
- Affiliations
- Philipps University of Marburg (DE)
- Corresponding author
- Nater, Urs M.
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 63
- Pages
- 68-77
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W1844096966
- Cited by
- 114
- References
- 65
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 14 · 2023: 11 · 2022: 10 · 2021: 15 · 2020: 13 · 2019: 10 · 2018: 9 · 2017: 10 · 2016: 8
- FWCI
- 7.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- University of Marburg
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- fibromyalgia, stress, pain, cortisol, alpha-amylase, hypothalamic-pituitary-adrenal axis, autonomic nervous system, women, ambulatory assessment
- MeSH terms
- Adult, Autonomic Nervous System, Female, Fibromyalgia, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Middle Aged, Pain, Pituitary-Adrenal System, Saliva, Stress, Psychological, Disease Progression, Salivary alpha-Amylases
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