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Chronic pain is often equated with chronic stress yet the relationship between chronic pain and hypothalamic-pituitary-adrenal (HPA) axis activity is poorly understood. The objective of this study was to examine diurnal functioning of the HPA axis in patients with clinically defined non-inflammatory chronic pain syndrome (CPS) compared to controls. The sample consisted of 37 adults with CPS and 47 healthy controls. All participants provided saliva samples at awakening, 12:00, 18:00 and 21:00 h on two consecutive days, as well as completing self-report questionnaires relating to anxiety and depression. The CPS group had a significantly lower overall mean diurnal salivary cortisol concentration compared to the control group (p < 0.01) but no significant differences were found between the two groups for repeated cortisol sampling across the day. However, a three-way interaction of time of day by patient status by sex was found (p < 0.032), with lower cortisol concentration in male patients compared to female patients in the afternoon period. No significant group effect was found for the rate of decline in the circadian rise in cortisol concentration. These data demonstrate that CPS is associated with a degree of hypocortisolemia, particularly in male patients. The altered dynamics of cortisol secretion in CPS in relation to the onset and duration of pain in patients remains to be determined.

Measurement of salivary cortisol can provide important information about hypothalamic-pituitary-adrenal (HPA) axis activity under normal conditions and in response to stress. However, there are many variables relating to the measurement of cortisol in saliva which may introduce error and therefore may render difficult the comparison and interpretation of data between, and within, laboratories. This review addresses the effects of gender, age, time and location of sampling, units of measurement, assay conditions and compliance with the protocol, all of which have the potential to impact upon the precision, accuracy and reliability of salivary cortisol measurements in the literature. Some of these factors are applicable to both adults and children, but the measurement of salivary cortisol in children introduces aspects of unique variability which demand special attention. The specific focus of this review is upon the somewhat neglected area of methodological variability of salivary cortisol measurement in children. In addition to these methodological issues, the review highlights the use of salivary cortisol measurements to provide information about HPA axis dysfunction associated with psycho- and patho-physiological conditions in children. Novel applications for salivary cortisol measurements in future research into HPA axis activity in children are also discussed.

The influence of family relations, maternal occupational characteristics, and childcare1The UK terms "childcare," childcare centres' and "nurseries" are used throughout this paper to define group care for children prior to starting their first year of formal schooling at age 4 years and are used synonymously with the American terms "day-care" and "preschool." This form of group care is provided in a formal setting, outside the family home and excludes "childminding" (i.e., childcare that may be group based and offered at the home of the care provider/childminder). In the UK, this form of childcare is offered from zero to 4 years old. Children are separated according to their age into small groups usually consisting of 10-15 children. In the present study, all children were in the preschool-aged group (3-4 years old). Where childcare of a different or more generic form is referred to, then this has been made clear in the context or stated in the text. utilization on preschool children's cortisol production were investigated in 56 mother-child dyads. Family characteristics and maternal employment, childcare and child temperament were reported by mothers. Morning and evening levels of children's salivary cortisol were obtained. Children in highly expressive or reserved families exhibited higher cortisol levels compared to children in moderately expressive families. Elevated levels of cortisol were detected in children of mothers reporting low levels of job role quality or high levels of emotional exhaustion. Frequent childcare use was found to protect children against the physiological effects of low maternal job role quality and emotional exhaustion. Findings underscore the pervasive role of the family as set within an external support system and highlight the potential physiological impact of these interacting contexts for children. Further research is needed to fully understand current findings and to develop appropriate psycho-physiological interventions., (Copyright 2005 Wiley Periodicals, Inc.)

Substantial recent research has focused on examining hormone indicators of psychosocial stress and on how relationships between stress and hormone changes might be linked to chronic illness. Particular attention has been paid to disease progression in cancer and HIV/AIDS. This focus has generated a plethora of research which has contributed both theoretically and clinically to the understanding of disease experience and the rate of disease progression. Measurement of salivary cortisol levels and diurnal variation has substantially advanced research methodology. Applying the unifying concept of allostasis and accumulated lifetime stress, this review attempts to assess the relevance of psychological and stress hormone correlates to disease resistance and health, through an examination of such correlates on the experience and outcomes of stress during childhood. Focus is on the role and importance of naturalistic social stress experiences such as school transition in healthy children, with emphasis on salivary cortisol as an endocrine marker of HPA-axis activation. It is argued that differing research perspectives offer valuable insight into the often assumed but largely unexplored links between early life experience and subsequent physical health outcomes in adulthood. Longitudinal studies incorporating measures of acute physical health outcome and of learning and memory are clearly needed.