Stress as a Key Concept in Chronic Widespread Pain and Fatigue Disorders

ABSTRACT.

Objectives: To review recent studies on the etiopathogenetic role and clinical relevance of life stress in medically unexplained syndromes characterized by chronic widespread musculoskeletal pain and fatigue.

Findings: Both fibromyalgia syndrome [FMS] and chronic fatigue syndrome [CFS] have been found to be frequently linked to different stressors, such as negative life events, occupational problems, posttraumatic stress [PTSD], adverse childhood experiences, and “overactive” lifestyle. In addition, the stress-modulating role of affect-regulation, perceptual-cognitive factors, and social support, as well as the relationship with depression have been investigated in FMS/CFS patients. However, methodological pitfalls and uncertainties about the neurobiological underpinnings of stress-related pain and fatigue prohibit definite conclusions from this research. Despite these limitations, the working hypothesis of “stress-system dysregulation” could be used in clinical practice with FMS/CFS patients as a valuable illness theory implying multiple handles for pragmatic help.

Conclusions: Further investigations, based on new theoretical stress-paradigms and sophisticated research strategies connecting psychological and neurobiological stress parameters, are needed to enhance our knowledge of the role of life stress in chronic widespread pain and fatigue disorders.

KEYWORDS. :

• Fibromyalgia syndrome
• chronic fatigue syndrome
• stress
• childhood trauma
• neurobiology