Elizabeth B. Klerman,
Don L. Goldenberg,
Emery N. Brown,
Anne M. Maliszewski and
Gail K. Adler
Endocrine-Hypertension Division, Department of Medicine, Brigham
and Women’s Hospital and Harvard Medical School (E.B.K., A.M.M.,
G.K.A.), Boston, Massachusetts 02115; Division of Rheumatology,
Newton-Wellesley Hospital (D.L.G.), Newton Massachusetts 02462;
Department of Medicine, Tufts University School of Medicine (D.L.G.),
Boston, Massachusetts 02111; and Department of Anesthesiology
and Critical Care, Harvard Medical School/Massachusetts Institute of
Technology Division of Health Sciences and Technology (E.N.B.), Boston,
Massachusetts 02114
Address all correspondence and requests for reprints to: Elizabeth B. Klerman, M.D., Ph.D., Circadian, Neuroendocrine, and Sleep Disorders Section, Endocrine-Hypertension Division, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, Massachusetts 02115. E-mail:
ebklerman{at}hms.harvard.edu
Fibromyalgia syndrome is a chronic and debilitating disorder
characterizedby widespread nonarticular musculoskeletal pain whose
etiologyis unknown. Many of the symptoms of this syndrome, including
difficultysleeping, fatigue, malaise, myalgias, gastrointestinal
complaints,and decreased cognitive function, are similar to those
observedin individuals whose circadian pacemaker is abnormally aligned
withtheir sleep-wake schedule or with local environmental time.
Abnormalitiesin melatonin and cortisol, two hormones whose secretion
is stronglyinfluenced by the circadian pacemaker, have been reported
inwomen with fibromyalgia. We studied the circadian rhythms of10
women with fibromyalgia and 12 control healthy women. Theprotocol
controlled factors known to affect markers of the circadiansystem,
including light levels, posture, sleep-wake state, meals,and activity.
The timing of the events in the protocol werecalculated relative to
the habitual sleep-wake schedule of eachindividual subject. Under
these conditions, we found no significantdifference between the women
with fibromyalgia and control womenin the circadian amplitude or phase
of rhythms of melatonin,cortisol, and core body temperature. The
average circadian phasesexpressed in hours posthabitual bedtime for
women with and withoutfibromyalgia were 3:43 ± 0:19 and
3:46 ± 0:13,respectively, for melatonin; 10:13 ± 0:23 and
10:32 ±0:20, respectively for cortisol; and 5:19 ± 0:19
and4:57 ± 0:33, respectively, for core body temperaturephases.
Both groups of women had similar circadian rhythms inself-reported
alertness. Although pain and stiffness were significantlyincreased in
women with fibromyalgia compared with healthy women,there were no
circadian rhythms in either parameter. We suggestthat abnormalities in
circadian rhythmicity are not a primarycause of fibromyalgia or its
symptoms.
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