The hypothalamic-pituitary-adrenal stress axis in fibromyalgia (FM) & Chronic Fatigue Syndrome (CFS)

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HPA axis abnormalities in FM, CFS, and other stress-related
disorders must be placed in a broad clinical context. We know
that interventions providing symptomatic improvement in
patients with FM and CFS can directly or indirectly affect the
HPA axis. These interventions include exercise, tricyclic
anti-depresssants, and serotonin reuptake inhibitors. There is
little direct information as to how the specific HPA axis
perturbations seen in FM can be related to the major
symptomatic manifestations of pain, fatigue, sleep
disturbance, and psychological distress. Since many of these
somatic and psychological symptoms are present in other
syndromes that exhibit HPA axis disturbances, it seems
reasonable to suggest that there may be some relationship
between basal and dynamic function of the HPA axis and
clinical manifestations of FM and CFS.

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