The etiology of fibromyalgia (FM) and other chronic musculoskeletal pain syndromes remains unclear. Treatment options are limited and often ineffective. Our group considers FM to be one of a spectrum of disorders characterized by dysregulated hypothalamic-pituitary-adrenal (HPA) axis function spanning both somatic and psychiatric syndromes. The HPA axis is a principal component of the coordinate stree-response system that is activated in response to both physical and psychological stimuli. There are interactions between the HPA axis and other systems contributing to linkage between the central nervous system and peripheral structures. Evidence of functional interaction between stress response systems and descending pain modulatory pathways exists. These findings suggest a role for the central nervous system in chronic musculoskeletal pain syndromes such as FM. Our research program is a multidisciplinary effort focused on basal and stimulated HPA axis function of patients with FM that is directed by the applicant. Our program has strong institutional support from units within the institution, including the general clinical research, psychology and the Institute for Social Research, psychiatry, neurology, and internal medicine. We have developed a database of patients with FM from which patients to participate in our research efforts are recruited. There is an ongoing effort to recruit appropriate patients to participate in our programs. There is a tremendous need for clinical research in the area of musculoskeletal pain. The applicant's efforts in this area have stimulated a programmatic effort at this institution that did not previously exist. Funding from the applicants research efforts have been secured, and trainees have been recruited to participate in the research program. This award will allow for continuing high quality patient-oriented research in central and peripheral neuroendocrine function in FM and other syndromes of chronic musculoskeletal pain.
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