Fibromyalgia and Stress

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Research has long supported the well-known fact that individuals with Fibromyalgia often report high levels of stress, and that stress can make the pain and other symptoms of the disease flare up or get worse. It is also widely believed that a particularly stressful life event may actually trigger the onset of Fibromyalgia in some people. New evidence is emerging to lend support for this theory.

A 2004 study by Gupta and Silman reviewed existing medical research to see if abnormalities in neuroendocrine function could explain the well-documented link between stress and Fibromyalgia. The term “neuroendocrine” refers to the interaction between the neurological and endocrine systems within the body. These two systems must work together in order to function, and generally do so through the production (endocrine) and exchange (neurological – endocrine) of various chemicals and hormones. This study reviewed in detail the abnormalities of some of these chemicals and hormones in Fibromyalgia patients, based on previous studies and research. The authors determined that chronic stress may result in changes to these various chemicals and hormones – including estrogen and serotonin – which may further result in the pain and fatigue associated with Fibromyalgia. The authors are careful, however, to note that the reverse could be true as well: the pain associated with Fibromyalgia may lead to psychological stress, which in turns may cause these chemicals and hormone levels to be abnormal. It could even be possible that both scenarios are possible as negative feedback loops reinforce each cause and symptom in turn. The authors note that further research using well-designed studies is needed.

On a similar note, a 2007 review article by Martinez-Lavin discussed in great detail the link between the body’s central nervous system (brain and spinal cord) and the regulation and perception of pain, including the pain characterized by Fibromyalgia. Based on accumulating evidence from researchers, Martinez-Levin described a scenario by which stress might cause the characteristic pain of Fibromyalgia. He suggested that for individuals with Fibromyalgia, a combination of genetic and environmental factors (including genetic predisposition, defective enzymes in the body, and chronic stress) collectively stimulate the body’s nervous system to the point that it remains in somewhat of a “hyperactive state.” Once the body is in that hyperactive state, a trigger event or major stressor can cause actual physical changes in the structure and function of the nervous system that result in the pain and tenderness associated with Fibromyalgia. The author describes Fibromyalgia as an unsuccessful attempt by the main regulatory system of the body to adapt to stress (Martinez-Lavin, 2007).

A recently published study from researchers in Spain investigated the link between stress and Fibromyalgia from the viewpoint that stress itself is a root cause of the disease. The researchers studied an emerging theory in the world of stress-related research which suggests that a person’s stress level is due to their perception of the stressful event or trigger, as well as individual characteristics such a self-esteem and self-efficacy (the ability to cope with difficult demands in life).

The authors used the Internet to contact members from various National Associations of Fibromyalgia and accepted into the study only those with a confirmed diagnosis of the disease. In total, 165 people were studied, and 93.9% were female. The authors used a number of self-administered questionnaires to gather their data for analysis. Study subjects completed questionnaires designed to measure each of the following: self-esteem, self-efficacy, social support, perceived stress, physical health, and the impact of Fibromyalgia on their daily life. Based on their findings, the authors discovered that for many of the individuals, certain personal and social resources (in particular self-esteem, self-efficacy, and social support) predicted an individual’s level of perceived stress. Furthermore, perceived stress appeared to be related to the impact of Fibromyalgia. These findings are important because they may provide other researchers with information on how to best approach the psychological aspect of treatment for Fibromyalgia.

Though research continues, it is clear that stress can be both a major causation factor associated with Fibromyalgia and a symptom that gets reinforced as the syndrome progresses.  Because stress (like poor sleep) plays such a pivotal role in the negative feedback loops that often characterize Fibromyalgia and make effective treatment so difficult, treatment efforts directed toward the reduction of stress are critical to any Fibromyalgia treatment program.

 

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 References

1.        Gupta A, Silman AJ. Psychological stress and Fibromyalgia: a review of the evidence suggesting a neuroendocrine link. Arthritis Res Ther. 2004;6(3):98-106.

2.      Martinez-Lavin M. Biology and therapy of Fibromyalgia. Stress, the stress response system, and Fibromyalgia. Arthritis Res Ther. 2007;9(4):216.s

3.      Gonzalez-Ramirez MT, Garcia-Campayo J, Landero-Hernandez R. The role of stress transactional theory on the development of Fibromyalgia: a structural equation model. Actas Esp Psiquiatr. 2011;39(2):81-87.

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