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How Low Cortisol Contributes to Fibromyalgia

Fibromyalgia (FM) is one of the most common chronic pain conditions and affects approximately 10 million people in the U.S. alone.  Although patients of all ages, genders, and ethnicities can be affected, up to 90 percent are women. The risk of acquiring FM increases with age.  In fact, approximately eight percent of adults meet the American College of Rheumatology classification of FM.

It may come as no surprise that many of the symptoms that characterize hypocortisol states and chronic fatigue syndrome are also seen in fibromyalgia.  They include:

  • Widespread, chronic muscle pain

  • Increased sensitivity to touch

  • Fatigue

  • Sleep disturbances

  • Morning stiffness

Patients with FM also experience more depression, anxiety, and psychosocial stress. FM often coexists with CFS, probably because the mechanisms through which both conditions arise are in parallel. However, in addition to being deficient in cortisol, FM patients may also have low levels of androgens (testosterone and DHEA), thyroid hormone, growth hormone, and catecholamines (epinephrine and norepinephrine).

Numerous studies on patients with FM have identified several important predisposing factors.  They include:

  • Emotional neglect

  • Victimization

  • Problems with school or vocation

  • Hereditary predisposition

  • Temperament

  • Early pain or disease experiences

These factors, coupled with family or job stress and a lack of ability to cope, can leave an individual especially vulnerable to developing FM.

Mirroring the findings in studies of patients with chronic fatigue syndrome, patients with FM display low daytime cortisol levels, inappropriate rises to cortisol in response to stressors, and dysfunction in the stress response system (‘HPA axis dysfunction’).  There have been no studies confirming that primary ‘adrenal fatigue’ is the cause of low cortisol states in FM patients or other patients with hypocortisolism.

Stress Response systme (HPA axis dysfunction)

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