Article Text

FRI0173 Reduced Hypothalamic-Pituitary-Adrenal Axis Activity in Chronic Widespread Pain: Partly Masked by Depressive and Anxiety Disorders
  1. E. Generaal1,
  2. N. Vogelzangs1,
  3. G.J. Macfarlane2,
  4. R. Geenen3,
  5. J.H. Smit1,
  6. B.W. Penninx1,
  7. J. Dekker4
  1. 1Psychiatry, VU University Medical Center, Amsterdam, Netherlands
  2. 2Pain Research Collaboration, University of Aberdeen, Aberdeen, United Kingdom
  3. 3Clinical and Health Psychology, Utrecht University, Utrecht
  4. 4Psychiatry and Rehabilitation Medicine, VU University Medical Center, Amsterdam, Netherlands


Background Results of studies on hypothalamic-pituitary-adrenal axis (HPA-axis) function amongst patients with chronic widespread pain (CWP) are equivocal and well-controlled cohort studies are rare in this field.

Objectives The goal of our study was to examine whether HPA-axis function is associated with the presence and the severity of CWP.

Methods Data are from the Netherlands Study of Depression and Anxiety including 1125 subjects with and without lifetime depressive and anxiety disorders. The Chronic Pain Grade questionnaire was used to determine the presence and severity of CWP. Subjects were categorized into a CWP group (n=471) and a control group (n=654). Salivary cortisol samples were collected to assess HPA-axis function (1-h awakening response, evening level, diurnal slope and post-dexamethasone level).

Results In comparison with the control group, subjects with CWP showed significantly lower awakening levels and a blunted diurnal slope, in particular among those without depressive/anxiety disorders. CWP subjects with depressive and/or anxiety disorders did not show altered cortisol levels.

Conclusions Our results suggest hypocortisolemia in CWP. However, if CWP is accompanied by depressive or anxiety disorder, typically related to hypercortisolemia1,2, the association between cortisol levels and CWP appears to be masked. Future studies should take psychopathology into account when examining HPA-axis function in CWP.


  1. Knorr U, Vinberg M, Kessing LV, Wetterslev J. Salivary cortisol in depressed patients versus control persons: a systematic review and meta-analysis. Psychoneuroendocrinology35(9);1275-86,2010.

  2. Vreeburg SA, Zitman FG, van PJ, Derijk RH, Verhagen JC, van DR, Hoogendijk WJ, Smit JH, Penninx BW. Salivary cortisol levels in persons with and without different anxiety disorders. Psychosom.Med.72(4);340-7,2010.

Acknowledgements This manuscript is part of the PhD programme investigating neurobiological dysregulation in chronic pain, funded through The European League Against Rheumatism (EULAR). The infrastructure for the NESDA study ( is funded through the Geestkracht program of the Netherlands Organisation for Health Research and Development (Zon-Mw, grant number 10-000-1002) and is supported by participating universities and mental health care organisations (VU University Medical Center, GGZ inGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, IQ Healthcare, Netherlands Institute for Health Services Research (NIVEL) and Netherlands Institute of Mental Health and Addiction (Trimbos)). There are no conflicts of interest.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.1497

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.