Abstract
Objective Patients suffering from chronic pain often present with multifactorial underlying conditions, sometimes without concrete pathological physical findings. Functional somatic syndromes (FSS) and somatoform disorders show a high prevalence of 8-20% and are often associated with adverse childhood experiences (ACE) and chronic stress. As many different FSS have overlapping symptoms, the concept of multisomatoform disorder (MSD) has been introduced as an encompassing concept. We hypothesize that a common neurohumoral profile is present in patients with MSD that is distinct from gender- and age-matched controls and thus provides insight into possible common underlying mechanisms. Design In 151 patients with MSD (138 females) and 149 matched controls (131 females), we determined ACE by the Childhood Trauma Questionnaire (CTQ) and chronic stress by the Trier Inventory for Chronic Stress (TICS). Furthermore, the serum levels of leptin, FSH, LH, cortisol, DHEA-S, and IGF-1 have been assessed. Results There were significant differences in the levels of leptin, FSH, IGF-1, and cortisol between patients and controls, mainly driven by female participants. Levels of leptin were significantly correlated with BMI in patients, in controls, and in the female subgroup. This correlation was exaggerated in female patients when compared to female controls. Both CTQ and TICS predicted MSD directly and indirectly through the levels of leptin. Conclusion There is evidence of a distinct neurohumoral profile in female patients with MSD when compared to matched healthy controls, similar to what has been demonstrated in other chronic pain states. The observed profile can be taken as possible evidence for a dysregulated response to chronic stress and metabolic balance as well as a state of hypocortisolism and HPA-axis dysfunction. ACE and chronic stress play a major role in the development of MSD and altered neurohumoral profile.
Highlights
Causes of chronic pain are often debilitating and multifactorial in origin while often lacking physical findings which adequately explain the presenting symptoms
This constellation of symptoms is present in multisomatoform disorder (MSD), which was originally suggested by Kroenke et al and serves as a common point of reference for patients in different somatic and psychosomatic specialties [1, 3]
We hypothesized that patients with MSD share a common hormonal profile distinct between patients and controls, hinting at underlying pathophysiological mechanisms
Summary
Causes of chronic pain are often debilitating and multifactorial in origin while often lacking physical findings which adequately explain the presenting symptoms. Somatoform disorders, a DSM-IV classification, and functional somatic symptoms (FSS) are among the most challenging of the possible etiologies with a prevalence of 8-20% [1,2,3]. In FSS such as fibromyalgia syndrome (FMS) or irritable bowel syndrome (IBS), physical findings that explain the presenting symptoms are absent even after comprehensive examinations and diagnostics. Distressing functional and disabling physical symptoms are often combined with severe chronic pain as the most prominent clinical complaint. This constellation of symptoms is present in multisomatoform disorder (MSD), which was originally suggested by Kroenke et al and serves as a common point of reference for patients in different somatic and psychosomatic specialties [1, 3]. There is a high prevalence of pain and pain-associated disability in patients with MSD as evidenced by pathologically altered scores in health questionnaires and elevated VAS scores compared with controls and other FSS or psychiatric disorders [1, 4]
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