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Enhanced negative feedback sensitivity of the hypothalamus–pituitary–adrenal axis in chronic myogenous facial pain ⋆
Author(s) -
Galli Ursula,
Gaab Jens,
Ettlin Dominik A.,
Ruggia Fidel,
Ehlert Ulrike,
Palla Sandro
Publication year - 2009
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/j.ejpain.2008.07.010
Subject(s) - dexamethasone , medicine , endocrinology , etiology , hypothalamic–pituitary–adrenal axis , chronic pain , hydrocortisone , glucocorticoid , hypothalamus , circadian rhythm , chronic stress , psychology , hormone , physical therapy
Dysregulations of the hypothalamus–pituitary–adrenal (HPA) axis, as a physiological substrate of stress, have been observed in patients with different stress‐related and chronic pain disorders. In this study, we investigated possible dysregulations of the HPA axis in patients with masticatory muscles pain. In 20 patients with myogenous facial pain and 20 healthy controls, awakening cortisol responses, i.e . cortisol rise in the first hour after awakening , as well as a short circadian free cortisol profile, i.e. four cortisol samples over 12h during the day , were assessed before and after administration of 0.5mg dexamethasone. Results: In comparison to controls, chronic myogenous facial pain patients showed enhanced and prolonged suppression of cortisol after the administration of 0.5mg dexamethasone. Unstimulated cortisol response ( before dexamethasone‐intake ) to awakening and cortisol levels during the day did not differ between the groups. Dysregulation in terms of enhanced negative feedback suppression exists in chronic myogenous facial pain. These results are in line with a multifactorial etiology of chronic facial pain, shifting the perspective away from a local towards a more central etiology with dysregulations in the stress and pain modulating system.