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Cited by 11Fibromyalgia and Chronic Fatigue Syndrome ResearchStress Responses and CortisolPsychosomatic Disorders and Their Treatments

Perceived and endocrine acute and chronic stress indicators in fibromyalgia syndrome

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Beiner, Eva, Hermes, Michelle, Reichert, Julian, Kleinke, Kristian, Vock, Stephanie, Löffler, Annette, Ader, Leonie, Sirazitdinov, Andrei +12 more·2024·Scientific Reports
DOI 10.1038/s41598-024-76635-zPMC PMC11649902
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Abstract

Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue and tenderness and closely associated with high levels of stress. FMS is therefore often considered a stress-related disease. A comparative study was conducted with 99 individuals diagnosed with FMS and a control group of 50 pain-free individuals. Stress indicators were classified into three categories: perceived stress assessed using the Perceived Stress Scale, and daily average salivary cortisol and hair cortisol concentrations as indicators of acute and chronic stress levels related to the hypothalamic-pituitary-adrenal axis. Analysis of variance and covariance were used to identify group differences and the influence of covariates age, sex, and body mass index. Correlational analyses further elucidated the relationship between stress indicators and clinical symptoms. Participants with FMS reported significantly higher perceived stress levels than controls (p < .001, η p2 = 0.3), which were positively correlated with symptom burden (r = .41, p < .001). In contrast, there were no significant differences in the endocrinological stress indicators salivary and hair cortisol between the groups (p > .05), nor were these indicators associated with clinical symptoms. The study highlights the central role of perceived stress in FMS, whereas endocrinological indicators did not differentiate FMS from controls. This finding calls for a nuanced approach to clinical assessment and therapeutic interventions tailored to patients with FMS, emphasizing the management of perceived stressors.

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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 Beiner et al. 2024

    The Introduction says HPA-axis stress responses may influence pain and symptom amplification in fibromyalgia, and the Results associate higher perceived stress with greater symptom severity. The paper does not identify central sensitisation pathways as the cause of exacerbations during a conflict; the Results also found no significant association between cortisol measures and clinical outcomes. The cited paper therefore supports a general stress–symptom link, not the specific mechanism or setting claimed. (LLM, conf=0.86)

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  • This study confirms the significant association between perceived stress and somatic symptom burden, manifesting as increased pain, anxiety, depression and general deterioration in health.

    “In line with previous research, this study confirms the significant association between perceived stress and somatic symptom burden, manifesting as increased pain, anxiety, depression and a general deterioration in health, highlighting the profound impact of stress in fibromyalgia populations (Malin and Littlejohn 2016; Beiner et al. 2024).”

    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 Beiner et al. 2024

    The Results section, under “Associations of stress dimensions and clinical symptoms” (page unavailable), reports significant associations of perceived stress with somatic symptom burden, pain severity and pain interference in the fibromyalgia group. Table 2 supports those associations, but the paper does not report corresponding associations with anxiety, depression or general deterioration in health. Its correlational findings also do not establish that stress caused symptoms to increase. (LLM, conf=0.88)

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Authors
Beiner, E., Hermes, M., Reichert, J., Kleinke, K., Vock, S., Löffler, A., Ader, L., Sirazitdinov, A., Keil, S., Schmidt, T., Schick, A., Löffler, M., Hopp, M., Ruckes, C., Hesser, J., Reininghaus, U., Flor, H., Eich, W., Friederich, H.-C., & Tesarz, J.
Affiliations
  • Heidelberg University (DE)
  • University of Siegen (DE)
  • University Medical Center of the Johannes Gutenberg University Mainz (DE)
  • King's College London (GB)
Corresponding author
Tesarz, Jonas
ORCID
Venue
Scientific Reports
Publisher
Springer Science and Business Media LLC
Published
2024-12-16
Volume
14
Issue
1
Pages
30471-30471
ISSN
2045-2322 (ISSN-L)
DOI
10.1038/s41598-024-76635-z
PMC
PMC11649902
OpenAlex
W4405422539
Cited by
11
References
18
Citations by year
2026: 6 · 2025: 4 · 2024: 1
FWCI
3.23
Type
journal article
Language
en
Open access
Licence
Locations
  • Scientific Reports (publishedVersion, cc-by)
  • medRxiv (acceptedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • RWTH Publications (RWTH Aachen) (submittedVersion, other-oa)
  • RWTH Publications (RWTH Aachen)
Funders
Universitätsklinikum Heidelberg
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, perceived stress, salivary cortisol, hair cortisol, hypothalamic-pituitary-adrenal axis, chronic stress, acute stress, symptom burden, stress management
MeSH terms
Adult, Female, Fibromyalgia, Hair, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Pituitary-Adrenal System, Saliva, Stress, Psychological, Case-Control Studies

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