Hypothalamus-Pituitary-Adrenal axis dysfunction in chronic widespread pain: literature analysis and disability evaluation

Abstract

Pain is a common disturbance and a frequent cause of work sick leave. Because the symptom is subjective (perceived), it hinders the expert evaluation. Chronic musculoskeletal pain, in particular, can lead to prolonged absenteeism, which places a substantial economic burden on employers and society. Therefore, forensic physicians, who evaluate work incapacity, take upon themselves a critically important task. A greater comprehension of the mechanisms that generate these clinical conditions, which include fibromyalgia and somatoform pain disorder, can help turn these mostly subjective assessments in more objective ones and consequently facilitate work capacity appraisal. Accordingly, scientific literature on hypothalamus-pituitary-adrenal axis function in the context of chronic generalized musculoskeletal pain published in the last 10 years was reviewed, but earlier articles were included for their relevance. It was noted that hormonal disturbances of this axis were not rare, but results are contradictory and it is not clear if the association occurs with pain or with the psychological symptoms frequently associated with these disorders. More studies are needed with a larger subject group.