Abstract
This systematic review and meta-analysis sought to gain further insight into the relationship between cortisol reactivity and chronic widespread pain in patients with fibromyalgia. The studies selected were those conducted in adults with fibromyalgia that were random controlled, non-controlled or observational. Studies were excluded if they examined diseases other than fibromyalgia or if they did not report on pain or cortisol. Twelve studies met inclusion criteria. Data were extracted into tabular format using predefined data fields by two reviewers and assessed for accuracy by a third reviewer. The methodological quality of the studies was assessed using the PEDro scale. Data Synthesis: Of 263 studies identified, 12 were selected for our review and 10 were finally included as their methodological quality was good. In the meta-analysis, we calculated effect sizes of interventions on pain indicators and cortisol levels in patients with fibromyalgia. A small overall effect of all the interventions was observed on pain tolerance and pressure pain thresholds, yet this effect lacked significance (ES = 0.150; 95%CI 0.932–1.550; p > 0.05). Conclusions: While some effects of individual nonpharmacological therapeutic interventions were observed on both cortisol levels and measures of pain, our results suggest much further work is needed to elucidate the true relationship between chronic widespread pain and cortisol levels in patients with fibromyalgia.
Highlights
Fibromyalgia (FM) is a complex multifactorial syndrome characterized by chronic widespread pain that is often accompanied by fatigue, cognitive problems and sleep disturbances causing a considerable decline in patient quality of life [1,2,3]
From the 263 records initially identified in this review over the past 10 years, 251 records were excluded (115 were duplicates; 30 were letters to the editor, notes, abstracts or meeting presentations; 7 articles were not written in English or Spanish; 79 articles were excluded since the main issue addressed was not related to fibromyalgia, cortisol and pain; and 22 because pain and cortisol outcomes were not provided)
The results of our meta-analysis indicate some individual effects of therapeutic interventions on both cortisol levels and several measures of pain though overall effect sizes were insignificant
Summary
Fibromyalgia (FM) is a complex multifactorial syndrome characterized by chronic widespread pain that is often accompanied by fatigue, cognitive problems and sleep disturbances causing a considerable decline in patient quality of life [1,2,3]. Several criteria have been defined for the classification, diagnosis and detection of FM, but criteria reflecting the present understanding of this disease that could help clinicians and researchers are lacking. This lack is clinically relevant during the clinical practice since criteria have to be valid, reliable and consistent to identify, assess and classify patients with FM and to make the most accurate treatment decision. With the goal of a multifaceted diagnosis, in 2013, a working group on fibromyalgia was created to assess new diagnostic approaches to help identify FM in clinical practice.
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