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Objective: Fatigue is a defining characteristic and one of the most debilitating features of fibromyalgia syndrome (FMS). The mechanisms underlying different dimensions of fatigue in FMS remain unclear. The aim of the current study was to test whether stress-related biological processes and physical activity modulate fatigue experience.Methods: Using an ambulatory assessment design, 26 female FMS patients reported general, mental, and physical fatigue levels at six time points per day for 14 consecutive days. Salivary cortisol and alpha-amylase were analyzed as markers of neuroendocrine functioning. Participants wore wrist actigraphs for the assessment of physical activity.Results: Lower increases in cortisol after awakening predicted higher mean daily general and physical fatigue levels. Additionally, mean daily physical activity positively predicted next-day mean general fatigue. Levels of physical fatigue at a specific time point were positively associated with momentary cortisol levels. The increase in cortisol after awakening did not mediate the physical activity - fatigue relationship. There were no associations between alpha-amylase and fatigue.Conclusion: Our findings imply that both changes in hypothalamic-pituitary-adrenal axis activity and physical activity contribute to variance in fatigue in the daily lives of patients with FMS. This study helps to paint a clearer picture of the biological and behavioral underpinnings of fatigue in FMS and highlight the necessity of interdisciplinary treatment approaches targeting biological, behavioral and psychological aspects of FMS. [ABSTRACT FROM AUTHOR]

Objective Although fibromyalgia syndrome (FMS) is a chronic condition, its cardinal symptom pain is known to fluctuate over the day. Stress has often been claimed to exacerbate pain; however, there is barely any evidence on whether or not this is true on a day-to-day basis (and, alternatively, on whether pain leads to increased stress levels). Using an ecologically valid measurement design, we tested whether and how stress and pain are intertwined in participants with FMS. We additionally examined the role of the two major stress-responsive systems, the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, as potential mediators of this relationship. Methods An ambulatory assessment study was conducted over the course of 14 days. On each day, 32 females with FMS provided six diary entries on momentary stress and pain levels. Saliva samples were collected at the same time points to determine cortisol and alpha-amylase as indicators of stress-responsive systems. Results Higher stress at a given measurement time point was associated with higher reported pain levels at the subsequent time point (UC = 1.47, p < 0.001), but not vice versa (UC < 0.01, p = 0.179). The stress-pain relationship was neither mediated by momentary cortisol nor by alpha-amylase; however, momentary cortisol was independently associated with momentary pain (UC = 0.27, p = 0.009). Conclusion Stress seems to be a powerful exacerbating factor for pain as experienced by patients with FMS in their everyday lives. Cortisol may be involved in the diurnal fluctuation of pain levels in patients with FMS. Future studies should identify relevant daily stressors in persons with FMS and scrutinize the mechanisms underlying the cortisol-pain relationship. [ABSTRACT FROM AUTHOR]

Medically unexplained fatigue is a burdensome, widespread symptom, and a frequent complaint in depressive disorders (DDs) as well as somatic symptom disorder (SSD). Heightened stress levels are a likely cause of fatigue, although the temporal associations, as well as the role of the stress-reactive hypothalamic-pituitary-adrenal (HPA) axis, are not yet completely understood. We were interested in the differences between DD and SSD regarding general, mental, and physical fatigue, as well as associations between psychobiological stress measures (representing different time frames) and fatigue in these groups. Fifty-eight women (29 with DD, 29 with SSD) reported subjective recent fatigue and chronic stress levels, as well as levels of depression and somatic complaints using baseline questionnaires. Furthermore, they completed an ambulatory assessment period comprising measurements of fatigue, subjective stress, and salivary cortisol five times a day for 14 consecutive days. Salivary cortisol was obtained as a measure of within-day HPA axis activity, and hair cortisol concentration was obtained as a measure of accumulated HPA axis activity of the preceding three months. Women with DD reported higher levels of general and mental fatigue than did women with SSD, which was explained by their higher level of depression. Physical fatigue levels did not differ between groups. In both groups, momentary general, mental, and physical fatigue levels were associated with momentary subjective stress but not with chronic stress. Momentary salivary cortisol levels were positively associated with mental fatigue, while hair cortisol concentration was not. There are differences in fatigue profiles between DD and SSD, which should be accounted for in future research and practice (e.g., individualized treatment strategies focusing on mental or physical fatigue, depending on which fatigue dimension is prominent). • Fatigue differs between depressive disorder (DD) and somatic symptom disorder (SSD). • Level of depression is related to everyday life mental, but not physical, fatigue. • Momentary stress is associated with momentary fatigue in DD and SSD. • Salivary cortisol is associated with mental, not physical, fatigue in DD and SSD. • Chronic stress and hair cortisol do not predict momentary fatigue in DD and SSD. [ABSTRACT FROM AUTHOR]

Summary The relation between music listening and stress is inconsistently reported across studies, with the major part of studies being set in experimental settings. Furthermore, the psychobiological mechanisms for a potential stress-reducing effect remain unclear. We examined the potential stress-reducing effect of music listening in everyday life using both subjective and objective indicators of stress. Fifty-five healthy university students were examined in an ambulatory assessment study, both during a regular term week (five days) and during an examination week (five days). Participants rated their current music-listening behavior and perceived stress levels four times per day, and a sub-sample ( n = 25) additionally provided saliva samples for the later analysis of cortisol and alpha-amylase on two consecutive days during both weeks. Results revealed that mere music listening was effective in reducing subjective stress levels ( p = 0.010). The most profound effects were found when ‘relaxation’ was stated as the reason for music listening, with subsequent decreases in subjective stress levels ( p ≤ 0.001) and lower cortisol concentrations ( p ≤ 0.001). Alpha-amylase varied as a function of the arousal of the selected music, with energizing music increasing and relaxing music decreasing alpha-amylase activity ( p = 0.025). These findings suggest that music listening can be considered a means of stress reduction in daily life, especially if it is listened to for the reason of relaxation. Furthermore, these results shed light on the physiological mechanisms underlying the stress-reducing effect of music, with music listening differentially affecting the physiological stress systems. [ABSTRACT FROM AUTHOR]