Fibromyalgia (FM) is a controversial syndrome, characterised by persistent widespread pain, abnormal pain sensitivity and additional symptoms such as fatigue and sleep disturbance. The syndrome largely overlaps with other functional somatic disorders, particularly chronic fatigue syndrome (CFS). Although the exact aetiology and pathogenesis of FM are still unknown, it has been suggested that stress may play a key role in the syndrome. This article first reviews the function of the stress response system, placing special emphasis on the relationships between adverse life experiences, stress regulation and pain-processing mechanisms, and summarising the evidence for a possible aetiopathogenetic role of stress in FM. Finally, an integrative biopsychosocial model that conceptualises FM as a stress disorder is proposed, and the clinical and research implications of the model are discussed.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, et al: The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: Report of the multicenter criteria committee. Arthritis Rheum 1990;36:160–172.
Petzke F, Gracely RH, Park KM, Ambrose K, Clauw DJ: What do tender points measure? Influence of distress on 4 measures of tenderness. J Rheumatol 2003;30:567–574.
Wessely S, Nimnuan C, Sharpe M: Functional somatic syndromes: One or many? Lancet 1999;354:936–939.
Henningsen P, Priebe S: New environmental illnesses: What are their characteristics? Psychother Psychosom 2003;72:231–234.
Clauw DJ, Chrousos GP: Chronic pain and fatigue syndromes: Overlapping clinical and neuroendocrine features and potential pathogenic mechanisms. Neuroimmunomodulation 1997;4:134–153.
Sullivan PF, Smith W, Buchwald D: Latent class analysis of symptoms associated with chronic fatigue syndrome and fibromyalgia. Psychol Med 2002;32:881–888.
Wessely S, Hotopf M: Is fibromyalgia a distinct clinical entity? Historical and epidemiological evidence. Baillière’s Clin Rheum 1999;13:427–436.
Ehrlich G: Fibromyalgia: A virtual disease. Clin Rheumatol 2003;22:8–12.
Hazemeijer I, Rasker JJ: Fibromyalgia and the therapeutic domain. A philosophical study on the origins of fibromyalgia in a specific social setting. Rheumatology 2003;42:507–515.
Van Houdenhove B. Fibromyalgia: A challenge for modern medicine. Clin Rheumatol 2003;22:1–5.
White KP, Speechley M, Harth M, Ostbye T: The London fibromyalgia epidemiology study. The prevalence of fibromyalgia in London, Ontario. J Rheumatol 1999;26:1570–1576.
Baumgartner E, Finckh A, Cedraschi C, Vischer TL: A six-year prospective study of a cohort of patients with fibromyalgia. Ann Rheum Dis 2002;61:644–645.
Rossy LA, Buckelew SP, Dorr N, Hagglund KJ, Thayer JF, McIntosh MJ, Hewett JE, Johnson JC: A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med 1999;21:180–191.
Sarnoch H, Adler F, Scholz OB: Relevance of muscular sensitivity, muscular activity, and cognitive variables for pain reduction associated with EMG feedback in fibromyalgia. Percept Mot Skills 1997;84:1043–1050.
Jacobsen S, Petersen IS, Danneskiold-Samsoe B: Clinical features in patients with chronic muscle pain with special reference to fibromyalgia. Scand J Rheumatol 1993;22:69–76.
Bradley LA, McKendree-Smith NL, Alarcon GS, Cianfrini LR: Is fibromyalgia a neurological disease? Curr Pain Headache Rep 2002;6:106–114.
Staud R, Smitherman ML: Peripheral and central sensitization in fibromyalgia: Pathogenetic role. Curr Pain Headache Rep 2002;6:259–266.
McBeth J, McFarlane GJ, Benjamin S, Silman AJ: Features of somatisation predict the onset of chronic widespread pain: Results of a large population-based study. Arthritis Rheum 2001;44:940–946.
White KP, Nielson WR, Harth M, Ostbye T, Speechley M: Chronic widespread pain with or without fibromyalgia: Psychological distress in a representative community adult sample. J Rheumatol 2002;29:588–594.
Cohen H, Neumann L, Haiman Y, Matar MA, Press J, Buskila D: Prevalence of posttraumatic stress disorder in fibromyalgia patients: Overlapping syndromes or posttraumatic fibromyalgia? Semin Arthritis Rheum 2002;32:38–50.
Goldenberg DL, Sandhu HS: Fibromyalgia and posttraumatic stress syndrome: Another piece in the biopsychosocial puzzle. Semin Arthritis Rheum 2002;32:1–2.
Chrousos GP, Gold PW: The concept of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA 1992;267:1244–1252.
McEwen BS: Protective and damaging effects of stress mediators. N Engl J Med 1998;338:171–179.
Chrousos GP, Gold PW: A healthy body in a healthy mind – and vice versa – the damaging power of ‘uncontrollable’ stress. J Clin Endocrinol Metab 1998;83:1842–1845.
Biondi M, Picardi A: Psychological stress and neuroendocrine function in humans: The last two decades of research. Psychother Psychosom 1999;68:114–150.
Liu D, Dioro J, Tannenbaum B, Caldji C, Francis D, Freedman A, Sharma S, Pearson D, Plotsky PM, Meaney MJ: Maternal care, hippocampal glucocorticoid receptors, and the hypothalamic-pituitary-adrenal responses to stress. Science 1997;277:1659–1662.
Champoux M, Bennett A, Shannon C, Highley JD, Lesch KP, Suomi SJ: Serotonin transporter gene polymorphism, differential early rearing, and behavior in rhesus monkey neonates. Mol Psychiatry 2002;7:1058–1063.
Newport DJ, Stowe ZN, Nemeroff CB: Parental depression: Animal models of an adverse life event. Am J Psychiatry 2002;159:1265–1283.
Brunson KL, Avishai-Eliner S, Hatalski CG, Baram TZ: Neurobiology of the stress response early in life: Evolution of a concept and the role of corticotropin-releasing hormone. Mol Psychiatry 2001;6:647–656.
Pine DS, Charney DS: Children, stress, and sensitization: An integration of basic and clinical research on emotion? Biol Psychiatry 2002;52:773–775.
McEwen BS: Plasticity of the hippocampus: Adaptation to chronic stress and allostatic load. Ann N Y Acad Sci 2001;933:265–277.
Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, Nemeroff CB: Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA 2000;284:592–597.
Heim C, Nemeroff CB: The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies. Biol Psychiatry 2001;49:1023–1039.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS: Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998;14:245–258.
Romans S, Belaise C, Martin J, Morris E, Raffi A: Childhood abuse and later medical disorders in women. An epidemiological study. Psychother Psychosom 2002;71:141–150.
Egle UT, Hardt J, Nickel R, Kappis B, Hoffmann SO: Early stress and its long-term effects on health – State of the art and implications for future research (in German). Z Psychosom Med Psychother 2002;48:411–434.
Essex MJ, Klein MH, Cho E, Kalin N: Maternal stress beginning in infancy may sensitize children to later stress exposure: Effects on cortisol and behavior. Biol Psychiatry 2002;52:776–784.
Gunnar MR, Brodersen L, Nachmias M, Buss K, Rigatuso J: Stress reactivity and attachment security. Dev Psychobiology 1996;29:191–204.
Gunnar MR: Quality of early care and buffering of neuroendocrine stress reactions: Potential effects on the developing brain. Prev Med 1998;27:208–211.
Graham YP, Heim C, Goodman SH, Miller AH, Nemeroff CB: The effects of neonatal stress on brain development: Implications for psychopathology. Dev Psychopathol 1999;11:545–565.
Shanks N: Early life environment: Does it have implications for predisposition to disease? Acta Neuropsychiatrica 2002;14:292–302.
Monk C, Pine DS, Charney DS: A developmental and neurobiological approach to early trauma research. Semin Clin Neuropsychiatry 2002;7:137–146.
Teicher MH, Andersen SL, Polcari A, Andersen CM, Navalta CP: Developmental neurobiology of childhood stress and trauma. Psychiatr Clin North Am 2002;25:397–426.
Charmandari E, Kino T, Souvatzoglu E, Chrousos GP: Pediatric stress: Hormonal mediators and human development. Horm Res 2003;59:161–179.
Van Houdenhove B: Psychosocial stress and pain. Eur J Pain 2000;4:225–228.
Melzack R: Pain and stress; in Gatchel RJ, Turk DC (eds): Psychosocial Aspects of Pain. Critical Perspectives. New York, Guilford, 1999, pp 89–106.
Larivière WR, Melzack R: The role of corticotropin-releasing factor in pain and analgesia. Pain 2000;84:1–12.
Okifuji A, Turk DC: Stress and psychophysiological dysregulation in patients with fibromyalgia syndrome. Appl Psychophysiol Biofeedback 2002;27:129–141.
Watkins LR, Maier SF: The pain of being sick. Implications of immune-to-brain communication for understanding pain. Ann Rev Psychol 2000;51:29–57.
Watkins LR, Maier SF: Beyond neurons: Evidence that immune and glia cells contribute to pathological pain states. Physiol Rev 2002;82:981–1011.
Maier SF: Bidirectional immune-brain communication: Implications for understanding stress, pain, and cognition. Brain Behav Immun 2003;17:69–85.
Lidow MS: Long-term effects of neonatal pain on nociceptive systems. Pain 2002;99:377–383.
Taddio A, Goldbach, Ipp M, Stevens B, Koren G: Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet 1995;345:291–292.
Ladd CO, Owens MJ, Nemeroff CB: Persistent changes in corticotropin-releasing factor neuronal systems induced by maternal deprivation. Endocrinology 1996;137:1212–1218.
Scarinci IC, McDonald-Haile J, Bradley LA, Richter JE: Altered pain perception and psychological features among women with gastrointestinal disorders and a history of abuse: A preliminary model. Am J Med 1994;97:108–118.
Kirby LG, Rice KC, Valentino RJ: Effects of corticotropin-releasing factor on neuronal activity in the serotonergic dorsal raphe nucleus. Neuropsychopharmacology 2000;22:148–162.
Price ML, Curtis AL, Kirby LG, Valentino RJ, Lucki I: Effects of corticotropin-releasing factor on brain serotonergic activity. Neuropsychopharmacology 1998;18:492–502.
Sandkühler J: The organisation and function of endogenous antinociceptive systems. Progr Neurobiol 1996;50:49–81.
Price DD: Psychological and neural mechanisms of the affective dimension of pain. Science 2000;288:1769–1772.
LeDoux JE: Emotion circuits in the brain. Annu Rev Neurosci 2000;23:155–184.
Sandkühler J: Learning and memory in pain pathways. Pain 2000;88:113–118.
McWilliams LA, CoxBJ, Enns MW: Impact of adult attachment styles on pain and disability associated with arthritis in a nationally representative sample. Clin J Pain 2000;16:360–364.
Maunder RG, Hunter JJ: Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosom Med 2001;63:556–567.
Ciechanowski P, Sullivan M, Jensen M, Romano J, Summers H: The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain 2003;104:627–637.
Buskila D, Neumann L, Hazanov I, Carmi R: Familial aggregation in the fibromyalgia syndrome. Semin Arthritis Rheum 1996;26:605–611.
Offenbaecher M, Bondi B, de Jonge S, Glatzeder K, Kruger M, Schoeps P, Ackenheil M: Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Arthritis Rheum 1999;42:2482–2488.
Van Houdenhove B, Neerinckx E, Lysens R, Vertommen H, Onghena P, Van Houdenhove L, Westhovens R, D’Hooghe MB: Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: A controlled study on prevalence and characteristics. Psychosomatics 2001;42:21–28.
Imbierowicz K, Egle UT: Childhood adversities in patients with fibromyalgia and somatoform pain disorder. Eur J Pain 2003;7:113–119.
Ruini C, Ottolini F, Rafanelli C, Tossani E, Ryff CD, Fava GA: The relationship between psychological well-being to distress and personality. Psychother Psychosom 2003;72:268–275.
Raphael KG, Widom CS, Lange G: Childhood victimization and pain in adulthood: A prospective investigation. Pain 2002;92:283–293.
Van Houdenhove B, Egle UT: Comment on Raphael et al. (letter to the editor). Pain 2002;96:216–217.
Lampe A, Doering S, Rumpold G, Solder E, Krismer M, Kantner-Rumplmair W, Schubert C, Sollner W: Chronic pain syndromes and their relation to childhood abuse and stressful life events. J Psychosom Res 2003;54:361–367.
Hardt J, Rutter M: Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence. J Child Adolesc Psychiatry, in press.
Egle UT, Rudolf ML, Hoffmann SO, Konig K, Schofer M, Schwab R, von Wilmowsky H: Personality markers, defence behavior and illness concept in patients with primary fibromyalgia. Z Rheumatol 1989;48:73–78.
Van Houdenhove B, Neerinckx E, Onghena P, Lysens R, Vertommen H: Premorbid ‘overactive’ lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship? J Psychosom Res 2001;51:571–576.
Johnson M, Panaanen ML, Rahinantti P, Hannonen P: Depressed fibromyalgia patients are equipped with an emphatic competence-dependent self-esteem. Clin Rheumatol 1997;16:578–584.
Anderberg UM, Marteinsdottir I, Theorell T, Von Knorring L: The impact of life events in female patients with fibromyalgia and in female healthy controls. Eur Psychiatry 2000;15:295–301.
Goldenberg DL: Fibromyalgia syndrome a decade later. What have we learned? Arch Intern Med 1999;159:777–785.
Hallberg LR, Carlsson S: Psychosocial vulnerability and maintaining forces related to fibromyalgia. Scand J Caring Sci 1998;12:95–103.
Poyhia R, Da Costa D, Fitzcharles MA: Previous experiences of women with fibromyalgia and inflammatory arthritis and nonpainful controls. J Rheumatol 2001;28:1888–1891.
Eich W, Hartmann M, Müller A, Fischer H: The role of psychosocial factors in fibromyalgia syndrome. Scand J Rheumatol Suppl 2000;29:30–31.
Dailey PA, Bishop GD, Russell JL, Fletcher EM: Psychological stress and the fibromyalgia/fibrositis syndrome. J Rheumatol 1990;17:1380–1385.
Van Houdenhove B, Neerinckx E, Onghena P, Lysens R, Vertommen H: Daily hassles reported by chronic fatigue syndrome and fibromyalgia patients in tertiary care: A controlled qualitative and quantitative study. Psychother Psychosom 2002;71:207–213.
Theorell T, Blomkvist V, Lindh G, Evengard B: Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): An examination of CFS patients and subjects with a non-specific life crisis. Psychosom Med 1999;61:304–310.
Pawlak CR, Witte T, Heiken H, Hundt M, Schubert J, Wiese B, Bischof-Renken A, Gerber K, Licht B, Goebel MU, Heijnen CJ, Schmidt RE, Schedlowski M: Flares in patients with systemic lupus erythematosus are associated with daily psychological stress. Psychother Psychosom 2003;72:159–165.
Picardi A, Pasquini P, Cattaruzza MS, Gaetano P, Melchi CF, Baliva G, Camaioni D, Tiago A, Abeni D, Biondi M: Stressful life events, social support, attachment security, and alexithymia in vitiligo: A case-control study. Psychother Psychosom 2003;72:150–158.
Raphael KG, Natelson BH, Janal MN, Nayak S: A community-based survey of fibromyalgia-like pain complaints following the World Trade Center terrorist attacks. Pain 2002;100:131–139.
Williams DA, Brown SC, Clauw DJ, Gendreau RM: Self-reported symptoms before and after September 11 in patients with fibromyalgia. JAMA 2003;289:1637–1638.
Hudson JI, Mangweth B, Pope HG jr, De Col C, Hausmann A, Gutweniger S, Laird MN, Biebl W, Tsuang MT: Family study of affective spectrum disorder. Arch Gen Psychiatry 2003;60:170–177.
Epstein SA, Kay G, Clauw D, Heaton R, Klein D, Krupp L, Kuck J, Leslie V, Masur D, Wagner M, Waid R, Zisook S: Psychiatric disorders in patients with fibromyalgia. A multicenter investigation. Psychosomatics 1999;40:57–63.
Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS: Chronic pain-associated depression: Antecedent or consequence of chronic pain? A review. Clin J Pain 1997;13:116–137.
Okifuji A, Turk DC, Sherman JJ: Evaluation of the relationship between depression and fibromyalgia syndrome: Why aren’t all patients depressed? J Rheumatol 2000;27:212–219.
Aaron LA, Bradley LA, Alarcon GS, Alexander RW, Triana-Alexander M, Martin MY, Alberts KR: Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking rather than to illness. Arthritis Rheum 1996;39:436–445.
De Gier M, Peters ML, Vlaeyen JWS: Fear of pain, physical performance, and attentional processes in patients with fibromyalgia. Pain 2003;104:121–130.
Celiker R, Borman P, Oktem F, Gokce-Kutsal Y, Basgoze O: Psychological disturbance in fibromyalgia: Relation to pain severity. Clin Rheumatol 1997;16:179–184.
McBeth J, McFarlane GJ, Benjamin S, Morris S, Silman AJ: The association between tender points, psychological distress, and adverse childhood experiences. Arthritis Rheum 1999;42:1397–1404.
Ahles TA, Khan SA, Yunus MR, Spiegel DA, Masi AT: Psychiatric status of patients with primary fibromyalgia, patients with rheumatoid arthritis, and subjects without pain: A blind comparison of DSM-III diagnoses. Am J Psychiatry 1991;148:1721–1726.
Kurtze N, Gundersen KT, Svebak S: The role of anxiety and depression in fatigue and patterns of pain among subgroups of fibromyalgia patients. Br J Med Psychol 1998;71:185–194.
Wolfe F, Hawley DJ: Evidence of disordered symptom appraisal in fibromyalgia: Increased rates of reported comorbidity and comorbidity severity. Clin Exp Rheumatol 1999;17:297–303.
Hallberg LR, Carlsson SG: Anxiety and coping in patients with chronic work-related muscular pain and patients with fibromyalgia. Eur J Pain 1998;25:309–319.
Hassett AL, Cone JD, Patella SJ, Sigal LH: The role of catastrophizing in the pain and depression of women with fibromyalgia syndrome. Arthritis Rheum 2000;43:2493–2500.
Crombez G, Eccleston C, Vandenbroeck A, Goubert L, Van Houdenhove B: Hypervigilance to pain in fibromyalgia: The mediating role of pain intensity and catastrophic thinking about pain. Clin J Pain, in press.
Burckhardt CS, Bjelle A: Perceived control: A comparison of women with fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus using a Swedish version of the Rheumatology Attitudes Index. Scand J Rheumatol 1996;25:300–306.
Vaeroy H, Qiao ZG, Morkrid L, Forre O: Altered sympathetic nervous system response in patients with fibromyalgia (fibrositis syndrome). J Rheumatol 1989;16:1460–1465.
Clauw DJ: Fibromyalgia: More than just a musculoskeletal disease. Am Fam Physician 1995;52:843–854.
Crofford LJ, Pillemer SR, Kalogeras KT, Cash JM, Michelsen D, Kling MA, Sternberg EM, Gold PW, Chrousos GP, Wilder RL: Hypothalamic-pituitary-adrenal axis perturbations in patients with fibromyalgia. Arthritis Rheum 1994;37:1583–1592.
Demitrack MA, Crofford LJ: Evidence for and pathophysiological implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann NY Acad Sci 1998;840:684–697.
Torpy DJ, Papanicolauou DA, Lotsikas AJ, Wilder RL, Chrousos GP, Pillemer SR: Responses of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis to interleukin-6: A pilot study in fibromyalgia. Arthritis Rheum 2000;43:872–880.
Gaab J, Huster D, Peisen R, Ehlert U: Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological, physiological, and pharmacological stimulation. Psychosom Med 2002;64:951–962.
Adler GK, Manfredsdottir VF, Creskoff KW: Neuroendocrine abnormalities in fibromyalgia. Curr Pain Headache Rep 2002;6:289–298.
Martinez-Lavin M, Barbosa RE, Pineda C, Casanova JM, Nava A: Norepinephrine-evoked pain in fibromyalgia. A randomized pilot study. BMC Musculoskelet Disord 2002;3:2.
Neeck G: Pathogenic mechanisms of fibromyalgia. Ageing Res Rev 2002;1:243–255.
Petzke F, Clauw DJ: Sympathetic nervous system function in fibromyalgia. Curr Rheumatol Rep 2000;2:116–123.
Geenen R, Jacobs JW, Bijlsma JW: Evaluation and management of endocrine function in fibromyalgia. Rheum Dis Clin North Am 2002;28:389–404.
Ehlert U, Gaab J, Heinrichs M: Psychoneuroendocrinological contributions to the etiology of depression, posttraumatic stress disorder, and stress-related bodily disorders: The role of the hypothalamus-pituitary-adrenal axis. Biol Psychol 2001;57:141–152.
Heim C, Ehlert U, Hellhammer DH: The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology 2000;25:1–35.
Yehuda R: Current status of cortisol findings in post-traumatic stress disorder. Psychiatr Clin North Am 2002;25:341–368.
Gold PW, Chrousos GP: Organization of the stress system and its dysregulation in melancholic and atypical depression: High vs. low CRH/NE, states. Mol Psychiatry 2002;7:254–275.
Parker AJ, Wessely S, Cleare AJ: The neuroendocrinology of chronic fatigue syndrome and fibromyalgia. Psychol Med 2001;31:1331–1345.
Anderberg UM, Uvnas-Moberg K: Plasma oxytocin levels in female fibromyalgia syndrome patients. Z Rheumatol 2000;59:373–379.
Anderberg UM: The role of sex hormones in pain response. Pain 2000;87:109–111.
Lautenbacher S, Rollman GB: Possible deficiencies of pain modulation in fibromyalgia. Clin J Pain 1997;13:89–196.
Mense S: Neurobiological concepts of fibromyalgia – the possible role of descending spinal tracts. Scand J Rheumatol Suppl 2000;113:24–29.
Bradley LA, McKendree-Smith NL, Alberts KR, Alarcon GS, Mountz GM, Deutsch G: The use of neuroimaging to understand abnormal pain sensitivity in fibromyalgia. Curr Rheumatol Rep 2000;2:141–148.
Gracely RH, Petzke F, Wolf JM, Clauw DJ: Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum 2002;46:1333–1344.
Wallace DJ, Linker-Israeli M, Hallegua D, Silverman S, Silver D, Weisman MH: Cytokines play an aetiopathogenetic role in fibromyalgia: A hypothesis and pilot study. Rheumatology 2001;40:743–749.
Van Houdenhove B: Listening to CFS. Why we should pay more attention to the story of the patient. J Psychosom Res 2002;52:495–499.
Van Houdenhove B: Comment on Cohen et al. (Letter to the editor). Semin Arthritis Rheum 2003;33:134–135.
Hellhammer DH, Wade S: Endocrine correlates of stress vulnerability. Psychother Psychosom 1993;60:8–17.
Winfield WB: Pain in fibromyalgia. Rheum Dis Clin North Am 1999;25:55–79.
Bauer ME, Vedhara K, Perks P, Wilcock GK, Lightman SL, Shanks N: Chronic stress in caregivers of dementia patients is associated with reduced lymphocyte sensitivity to glucocorticoids. J Neuroimmunol 2000;103:84–92.
Gunnar MR, Vazquez DM: Low cortisol and a flattening of expected daytime rhythm: Potential indices of risk in human development. Dev Psychopathol 2001;13:515–538.
Turk DC, Okifuji A, Starz TW, Sinclair JD: Effect of symptom onset on psychological distress and disability in fibromyalgia syndrome patients. Pain 1996;68:423–430.
Hurtig IM, Raak RI, Kendall SA, Gerdle B, Wahren LK: Quantitative sensory testing in fibromyalgia patients and healthy subjects: Identification of subgroups. Clin J Pain 2001;17:316–322.
Masi AT, White KP, Pilcher JJ: A person-centered approach to care, teaching, and research in fibromyalgia syndrome: Justification from biopsychosocial perspectives in populations. Semin Arthritis Rheum 2002;32:71–93.
Williams DA: Psychological and behavioural therapies in fibromyalgia and related syndromes. Best Pract Res Clin Rheum 2003;17:649–665.
van Hout MSE, Wekking EM, Berg IJ, Deelman BG: Psychological treatment of patients with chronic toxic encephalopathy: Lessons from studies of chronic fatigue and whiplash. Psychother Psychosom 2003;72:235–244.
Mannerkorpi K, Iversen MD: Physical exercise in fibromyalgia and related syndromes. Best Pract Res Clin Rheum 2003;17:629–647.
Myin-Germeys L, Peeters F, Havermans R, Nicolson NA, DeVries MW, Delespaul P, van Os J: Emotional reactivity to daily life stress in psychosis and affective disorder: An experience sample study. Acta Psychiatr Scand 2003;107:124–131.
Cleare AJ: The neuroendocrinology of chronic fatigue syndrome. Endocr Rev 2003;24:236–252.
Crofford L, Russell IJ, Mease P, Corbin A, Young J, LaMoreaux L, Martin S, Sharma U, Knapp L, Versavel M, Poole RM: Pregabalin improves pain associated with fibromyalgia syndrome in a multicenter, randomized, placebo-controlled monotherapy trial (abstract 1653). Arthritis Rheum 2002;46(suppl 9):S613.
Tsigos C, Chrousos GP: Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res 2002;53:865–871.
Watkins LR, Milligan ED, Maier SF: Glial proinflammatory cytokines mediate exaggerated pain states: Implications for clinical pain. Adv Exp Med Biol 2003;521:1–21.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.