Stress as a Key Concept in Chronic Widespread Pain and Fatigue Disorders

Objectives: To review recent studies on the etiopathogenetic role and clinical relevance of life stress in medically unexplained syndromes characterized by chronic widespread musculoskeletal pain and fatigue. Findings: Both fibromyalgia syndrome [FMS] and chronic fatigue syndrome [CFS] have been found to be frequently linked to different stressors, such as negative life events, occupational problems, posttraumatic stress [PTSD], adverse childhood experiences, and "overactive" lifestyle. In addition, the stress-modulating role of affect-regulation, perceptual-cognitive factors, and social support, as well as the relationship with depression have been investigated in FMS/CFS patients. However, methodological pitfalls and uncertainties about the neurobiological underpinnings of stress-related pain and fatigue prohibit definite conclusions from this research. Despite these limitations, the working hypothesis of "stress-system dysregulation" could be used in clinical practice with FMS/CFS patients as a valuable illness theory implying multiple handles for pragmatic help. Conclusions: Further investigations, based on new theoretical stress-paradigms and sophisticated research strategies connecting psychological and neurobiological stress parameters, are needed to enhance our knowledge of the role of life stress in chronic widespread pain and fatigue disorders.