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Circadian Rhythms of Women with Fibromyalgia¹

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 characterized by widespread nonarticular musculoskeletal pain whose etiology is unknown. Many of the symptoms of this syndrome, including difficulty sleeping, fatigue, malaise, myalgias, gastrointestinal complaints, and decreased cognitive function, are similar to those observed in individuals whose circadian pacemaker is abnormally aligned with their sleep-wake schedule or with local environmental time. Abnormalities in melatonin and cortisol, two hormones whose secretion is strongly influenced by the circadian pacemaker, have been reported in women with fibromyalgia. We studied the circadian rhythms of 10 women with fibromyalgia and 12 control healthy women. The protocol controlled factors known to affect markers of the circadian system, including light levels, posture, sleep-wake state, meals, and activity. The timing of the events in the protocol were calculated relative to the habitual sleep-wake schedule of each individual subject. Under these conditions, we found no significant difference between the women with fibromyalgia and control women in the circadian amplitude or phase of rhythms of melatonin, cortisol, and core body temperature. The average circadian phases expressed in hours posthabitual bedtime for women with and without fibromyalgia 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 and 4:57 ± 0:33, respectively, for core body temperature phases. Both groups of women had similar circadian rhythms in self-reported alertness. Although pain and stiffness were significantly increased in women with fibromyalgia compared with healthy women, there were no circadian rhythms in either parameter. We suggest that abnormalities in circadian rhythmicity are not a primary cause of fibromyalgia or its symptoms.

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