Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2013

Open Access 01-12-2013 | Research article

Trapezius activity of fibromyalgia patients is enhanced in stressful situations, but is similar to healthy controls in a quiet naturalistic setting: a case-control study

Authors: Rolf Harald Westgaard, Paul Jarle Mork, Håvard Wuttudal Lorås, Roberto Riva, Ulf Lundberg

Published in: BMC Musculoskeletal Disorders | Issue 1/2013

Login to get access

Abstract

Background

Muscle activity and pain development of fibromyalgia (FM) patients in response to mental stress show inconsistent results, when compared to healthy controls (HCs). A possible reason for the inconsistent results is the large variation in stress exposures in different studies. This study compares muscle responses of FM patients and HCs for different modes and levels of imposed stress, to elucidate features in stress exposures that distinguish stress responses of FM patients from HCs.

Methods

Upper trapezius (clavicular and acromial fibers), deltoid, and biceps surface electromyographic (sEMG) activity was recorded in FM patients (n=26) and HCs (n=25). Heart rate (HR) was recorded and used as indicator of autonomic activation. Tests included inspiratory breath holding (sympathetic activation procedure), mental stress tests (color-word test and backward counting; 28 min), instructed rest prior to stress test (30 min TV watching), and controlled arm movement. sEMG and HR was also recorded during an unrestrained evening stay at a patient hotel. The 5-min period with lowest trapezius muscle activity was determined. Pain (shoulder/neck, low back pain) and perceived tension were scored on VAS scales at the start and the end of the stress test and at bedtime.

Results

Trapezius sEMG responses of FM patients were significantly higher than HCs during sympathetic activation, mental stress, and instructed rest, but similar during arm movement and unrestrained evening activity. HR of FM patients and HCs was similar during mental stress and in the evening, including the 5-min period with lowest trapezius activity. Muscle activity of FM patients during the stress test (with shoulder/neck pain development) and the evening stay (no pain development) was similar.

Conclusions

FM patients show elevated muscle activity (in particular trapezius activity) in situations with imposed stress, including sympathetic activation, and putative anticipatory stress. Muscle activity and HR were similar to HCs in instructed arm movement and in a situation approaching low-stress daily living. Pain development of FM patients during the stress test may be due to activation of several stress-associated physiological systems, and not obviously caused by muscle activity in isolation.
Appendix
Available only for authorised users
Literature
1.
Ablin J, Neumann L, Buskila D: Pathogenesis of fibromyalgia: a review. Joint Bone Spine. 2008, 75: 273-279. 10.1016/j.jbspin.2007.09.010.CrossRefPubMed
2.
Adler GK, Kinsley BT, Hurwitz S, Mossey CJ, Goldenberg DL: Reduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome. Am J Med. 1999, 106: 534-543. 10.1016/S0002-9343(99)00074-1.CrossRefPubMed
3.
Adler GK, Manfredsdottir VF, Rackow RM: Hypothalamic-pituitary-adrenal axis function in fibromyalgia and chronic fatigue syndrome. Endocrinologist. 2002, 12: 513-524. 10.1097/00019616-200211000-00008.CrossRef
4.
Cohen H, Neumann L, Shore M, Amir M, Cassuto Y, Buskila D: Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum. 2000, 29: 217-227. 10.1016/S0049-0172(00)80010-4.CrossRefPubMed
5.
Desmeules JA, Cedraschi C, Rapiti E, Baumgartner E, Finckh A, Cohen P, Dayer P, Vischer TL: Neurophysiologic evidence for a central sensitization in patients with fibromyalgia. Arthritis Rheum. 2003, 48: 1420-1429. 10.1002/art.10893.CrossRefPubMed
6.
7.
Vierck CJ: Mechanisms underlying development of spatially distributed chronic pain (fibromyalgia). Pain. 2006, 124: 242-263. 10.1016/j.pain.2006.06.001.CrossRefPubMed
8.
Ge HY, Nie HL, Madeleine P, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L: Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain. 2009, 147: 233-240. 10.1016/j.pain.2009.09.019.CrossRefPubMed
9.
Harth M, Nielson WR: The fibromyalgia tender points: use them or lose them? A brief review of the controversy. J Rheumatol. 2007, 34: 914-922.PubMed
10.
Bengtsson A: The muscle in fibromyalgia. Rheumatol. 2002, 41: 721-724. 10.1093/rheumatology/41.7.721.CrossRef
11.
Bazzichi L, Dini M, Rossi A, Corbianco S, De Feo F, Giacomelli C, Zirafa C, Ferrari C, Rossi B, Bombardieri S: Muscle modifications in fibromyalgic patients revealed by surface electromyography (SEMG) analysis. BMC Musculoskelet Disord. 2009, 10: 36-10.1186/1471-2474-10-36.CrossRefPubMedPubMedCentral
12.
Casale R, Sarzi-Puttini P, Atzeni F, Gazzoni M, Buskila D, Rainoldi A: Central motor control failure in fibromyalgia: a surface electromyography study. BMC Musculoskelet Disord. 2009, 10: 78-10.1186/1471-2474-10-78.CrossRefPubMedPubMedCentral
13.
Elert J, Kendall SA, Larsson B, Mansson B, Gerdle B: Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders. J Rheumatol. 2001, 28: 1361-1368.PubMed
14.
Gerdle B, Lemming D, Kristiansen J, Larsson B, Peolsson M, Rosendal L: Biochemical alterations in the trapezius muscle of patients with chronic whiplash associated disorders (WAD) - a microdialysis study. Eur J Pain. 2008, 12: 82-93. 10.1016/j.ejpain.2007.03.009.CrossRefPubMed
15.
Wærsted M, Westgaard RH: Attention-related muscle activity in different body regions during VDU work with minimal physical activity. Ergonomics. 1996, 39: 661-676. 10.1080/00140139608964488.CrossRefPubMed
16.
Clauw DJ, Williams DA: Relationship between stress and pain in work-related upper extremity disorders: the hidden role of chronic multisymptom illnesses. Am J Ind Med. 2002, 41: 370-382. 10.1002/ajim.10068.CrossRefPubMed
17.
Okifuji A, Turk DC: Stress and psychophysiological dysregulation in patients with fibromyalgia syndrome. Appl Psychophysiol Biofeedback. 2002, 27: 129-141. 10.1023/A:1016243710507.CrossRefPubMed
18.
Sarzi-Puttini P, Atzeni F, Diana A, Doria A, Furlan R: Increased neural sympathetic activation in fibromyalgia syndrome. Ann New York Acad Sci. 2006, 1069: 109-117. 10.1196/annals.1351.009.CrossRef
19.
Bansevicius D, Westgaard RH, Stiles T: EMG activity and pain development in fibromyalgia patients exposed to mental stress of long duration. Scand J Rheumatol. 2001, 30: 92-98. 10.1080/03009740151095367.CrossRefPubMed
20.
Nilsen KB, Westgaard RH, Stovner LJ, Helde G, Rø M, Sand TH: Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography. Eur J Pain. 2006, 10: 615-627. 10.1016/j.ejpain.2005.10.001.CrossRefPubMed
21.
Wærsted M, Bjørklund RA, Westgaard RH: The effect of motivation on shoulder-muscle tension in attention-demanding tasks. Ergonomics. 1994, 37: 363-376. 10.1080/00140139408963652.CrossRefPubMed
22.
Thieme K, Turk DC: Heterogenity of psychophysiological stress responses in fibromyalgia syndrome patients. Arthritis Res Ther. 2006, 8: R9-10.1186/ar1863.CrossRefPubMed
23.
Müller W, Schneider EM, Stratz T: The classification of fibromyalgia syndrome. Rheumatol Int. 2007, 27: 1005-1010. 10.1007/s00296-007-0403-9.CrossRefPubMed
24.
Wilson HD, Robinson JP, Turk DC: Toward the identification of symptom patterns in people with fibromyalgia. Arthritis Rheum. 2009, 61: 527-534. 10.1002/art.24163.CrossRefPubMedPubMedCentral
25.
Jensen C, Westgaard RH: Functional subdivision of the upper trapezius muscle during low-level activation. Eur J Appl Physiol. 1997, 76: 335-339. 10.1007/s004210050257.CrossRef
26.
Mathiassen SE, Winkel J, Hägg GM: Normalization of surface EMG amplitude from the upper trapezius muscle in ergonomic studies - A review. J Electromyograph Kinesiol. 1995, 5: 197-226. 10.1016/1050-6411(94)00014-X.CrossRef
27.
Holte KA, Vasseljen O, Westgaard RH: Exploring perceived tension as a response to psychosocial work stress. Scand J Work Environ Health. 2003, 29: 124-133. 10.5271/sjweh.714.CrossRefPubMed
28.
Vasseljen O, Holte KA, Westgaard RH: Shoulder and neck complaints in customer relations: individual risk factors and perceived exposures at work. Ergonomics. 2001, 44: 355-372. 10.1080/00140130010008101.CrossRefPubMed
29.
Vasseljen O, Westgaard RH: A case–control study of trapezius muscle-activity in office and manual workers with shoulder and neck pain and symptom-free controls. Int Arch Occup Environ Health. 1995, 67: 11-18. 10.1007/BF00383127.CrossRefPubMed
30.
Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA, Hamaty D, Lessard J, Lichtbroun AS, Masi AT, Mccain GA, Reynolds WJ, Romano TJ, Russell IJ, Sheon RP: The American College of Rheumatology 1990 criteria for the classification of Fibromyalgia. Arthritis Rheum. 1990, 33: 160-172. 10.1002/art.1780330203.CrossRefPubMed
31.
Riva R, Mork PJ, Westgaard RH, Rø M, Lundberg U: Fibromyalgia syndrome is associated with hypocortisolism. Int J Behav Med. 2010, 17: 223-233. 10.1007/s12529-010-9097-6.CrossRefPubMed
32.
Riva R, Mork PJ, Westgaard RH, Lundberg U: Comparison of the cortisol awakening response in women with shoulder and neck pain and women with fibromyalgia. Psychoneuroendocrinology. 2012, 37: 299-306. 10.1016/j.psyneuen.2011.06.014.CrossRefPubMed
33.
Riva R, Mork PJ, Westgaard RH, Johansen TO, Lundberg U: Catecholamines and heart rate in female fibromyalgia patients. J Psychosom Res. 2012, 72: 51-57. 10.1016/j.jpsychores.2011.09.010.CrossRefPubMed
34.
Mork PJ, Nilsson J, Lorås HW, Riva R, Lundberg U, Westgaard RH: Heart rate variability in fibromyalgia patients and healthy controls during non-REM and REM sleep: a case–control study. Scandinavian Journal of Reumatology. 2013, in press
35.
Lundberg U, Kadefors R, Melin B, Palmerud G, Hassmen P, Engström M, Dohns IE: Psychophysiological stress and EMG activity of the trapezius muscle. Int J Behav Med. 1994, 1: 354-370. 10.1207/s15327558ijbm0104_5.CrossRefPubMed
36.
Chung JW, Ohrbach R, Mccall WD: Effect of increased sympathetic activity on electrical activity from myofascial painful areas. Am J Phys Med Rehabil. 2004, 83: 842-850. 10.1097/01.PHM.0000143399.34798.A7.CrossRefPubMed
37.
Macefield VG, Wallin BG: Effects of static lung-inflation on sympathetic activity in human muscle nerves at rest and during asphyxia. J Auton Nerv Syst. 1995, 53: 148-156. 10.1016/0165-1838(94)00174-I.CrossRefPubMed
38.
Westgaard RH, Bjørklund R: Generation of muscle tension additional to postural muscle load. Ergonomics. 1987, 30: 911-923. 10.1080/00140138708969787.CrossRefPubMed
39.
Stein PK, Bosner MS, Kleiger RE, Conger BM: Heart rate variability: a measure of cardiac autonomic tone. Am Heart J. 1994, 127: 1376-1381. 10.1016/0002-8703(94)90059-0.CrossRefPubMed
40.
Berntson GG, Bigger JT, Eckberg DL, Grossman P, Kaufmann PG, Malik M, Nagaraja HN, Porges SW, Saul JP, Stone PH, Van der Molen MW: Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology. 1997, 34: 623-648. 10.1111/j.1469-8986.1997.tb02140.x.CrossRefPubMed
41.
Jensen C, Vasseljen O, Westgaard RH: The influence of electrode position on bipolar surface electromyogram recordings of the upper trapezius muscle. Eur J Appl Physiol. 1993, 67: 266-273. 10.1007/BF00864227.CrossRef
42.
Jensen C, Vasseljen O, Westgaard RH: Estimating maximal EMG amplitude for the trapezius muscle: on the optimization of experimental procedure and electrode placement for improved reliability and increased signal amplitude. J Electromyograph Kinesiol. 1996, 6: 51-58. 10.1016/1050-6411(94)00012-3.CrossRef
43.
Mork PJ, Westgaard RH: Low-amplitude trapezius activity in work and leisure and the relation to shoulder and neck pain. J Appl Physiol. 2006, 100: 1142-1149.CrossRefPubMed
44.
Eriksen HR, Ihlebæk C, Ursin H: A scoring system for subjective health complaints (SHC). Scand J Public Health. 1999, 27: 63-72.CrossRefPubMed
45.
Schalling D, Edman G: Personality and vulnerability to psychopathology: the development of the Karolinska Scales of Personality (KSP). 1987, Stockholm, Sweden: Karolinska Institutet
46.
Field A: Discovering statistics using SPSS. 2005, London: SAGE Publications Ltd
47.
Fagius J, Berne C: The increase in sympathetic nerve activity after glucose ingestion is reduced in type I diabetes. Clin Sci. 2000, 98: 627-632. 10.1042/CS19990330.CrossRefPubMed
48.
Landsberg L: A teleological view of obesity, diabetes and hypertension. Clin Exp Pharmacol Physiol. 2006, 33: 863-867. 10.1111/j.1440-1681.2006.04455.x.CrossRefPubMed
49.
Westgaard RH, Bonato P, Westad C: Respiratory and stress-induced activation of low-threshold motor units in the human trapezius muscle. Exp Brain Res. 2006, 175: 689-701. 10.1007/s00221-006-0587-3.CrossRefPubMed
50.
Cohen H, Neumann L, Alhosshle A, Kotler M, Abu-Shakra M, Buskila D: Abnormal sympathovagal balance in men with fibromyalgia. J Rheumatol. 2001, 28: 581-589.PubMed
51.
Furlan R, Colombo S, Perego F, Atzeni F, Diana A, Barbic F, Porta A, Pace F, Malliani A, Sarzi-Puttini P: Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia. J Rheumatol. 2005, 32: 1787-1793.PubMed
52.
Kanbara K, Fukunaga M, Mutsuura H, Takeuchi H, Kitamura K, Nakai Y: An exploratory study of subgrouping of patients with functional somatic syndrome based on the psychophysiological stress response: its relationship with moods and subjective variables. Psychosom Med. 2007, 69: 158-165. 10.1097/PSY.0b013e3180312cac.CrossRefPubMed
53.
Nilsen KB, Sand T, Westgaard RH, Stovner LJ, White LR, Leistad RB, Helde G, Rø M: Autonomic activation and pain in response to low-grade mental stress in fibromyalgia and shoulder/neck pain patients. Eur J Pain. 2007, 11: 743-755. 10.1016/j.ejpain.2006.11.004.CrossRefPubMed
54.
Falla D, Andersen H, Danneskiold-Samsøe B, Arendt-Nielsen L, Farina D: Adaptations of upper trapezius muscle activity during sustained contractions in women with fibromyalgia. J Electromyograph Kinesiol. 2010, 20: 457-464. 10.1016/j.jelekin.2009.07.002.CrossRef
55.
Farina D, Merletti R, Enoka RM: The extraction of neural strategies from the surface EMG. J Appl Physiol. 2004, 96: 1486-1495. 10.1152/japplphysiol.01070.2003.CrossRefPubMed
56.
Rosendal L, Kristiansen J, Gerdle B, Søgaard K, Peolsson M, Kjær M, Sørensen J, Larsson B: Increased levels of interstitial potassium but normal levels of muscle IL-6 and LDH in patients with trapezius myalgia. Pain. 2005, 119: 201-209. 10.1016/j.pain.2005.09.026.CrossRefPubMed
57.
Schweinhardt P, Sauro KM, Bushnell MC: Fibromyalgia: a disorder of the brain?. Neuroscientist. 2008, 14: 415-421.CrossRefPubMed
58.
59.
Le Goff P: Is fibromyalgia a muscle disorder?. Joint Bone Spine. 2006, 73: 239-242. 10.1016/j.jbspin.2005.03.022.CrossRefPubMed
60.
Andersen LL, Suetta C, Andersen JL, Kjær M, Sjøgaard G: Increased proportion of megafibers in chronically painful muscles. Pain. 2008, 139: 588-593. 10.1016/j.pain.2008.06.013.CrossRefPubMed
61.
Rosendal L, Larsson B, Kristiansen J, Peolsson M, Søgaard K, Kjær M, Sørensen J, Gerdle B: Increase in muscle nociceptive substances and anaerobic metabolism in patients with trapezius myalgia: microdialysis in rest and during exercise. Pain. 2004, 112: 324-334. 10.1016/j.pain.2004.09.017.CrossRefPubMed
62.
Staud R, Nagel S, Robinson ME, Price DD: Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. Pain. 2009, 145: 96-104. 10.1016/j.pain.2009.05.020.CrossRefPubMedPubMedCentral
63.
Mork PJ, Westgaard RH: Long-term electromyographic activity in upper trapezius and low back muscles of women with moderate physical activity. J Appl Physiol. 2005, 99: 570-578. 10.1152/japplphysiol.00198.2005.CrossRefPubMed
64.
Simons DG, Hong CZ, Simons LS: Endplate potentials are common to midfiber myofacial trigger points. Am J Phys Med Rehabil. 2002, 81: 212-222. 10.1097/00002060-200203000-00010.CrossRefPubMed
65.
Griep E, Boersma J, de Kloet E: Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome. J Rheumatol. 1993, 20: 469-474.PubMed
66.
Malik M, Bigger JT, Camm AJ, Kleiger RE, Malliani A, Moss AJ, Schwartz PJ: Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Eur Heart J. 1996, 17: 354-381. 10.1093/oxfordjournals.eurheartj.a014868.CrossRef
Metadata
Title
Trapezius activity of fibromyalgia patients is enhanced in stressful situations, but is similar to healthy controls in a quiet naturalistic setting: a case-control study
Authors
Rolf Harald Westgaard
Paul Jarle Mork
Håvard Wuttudal Lorås
Roberto Riva
Ulf Lundberg
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2013
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-14-97

Other articles of this Issue 1/2013

BMC Musculoskeletal Disorders 1/2013 Go to the issue

Study protocol

Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial

Research article

Early application of pulsed electromagnetic field in the treatment of postoperative delayed union of long-bone fractures: a prospective randomized controlled study

Research article

The relationship between health promoting resources and work participation in a sample reporting musculoskeletal pain from the Nord-Trøndelag Health Study, HUNT 3, Norway

Research article

Efficacy and safety of tofacitinib in the treatment of rheumatoid arthritis: a systematic review and meta-analysis

Research article

Bilateral and multiple cavitation sounds during upper cervical thrust manipulation

Research article

Evaluation of a treatment algorithm for acute traumatic osseous Bankart lesions resulting from first time dislocation of the shoulder with a two year follow-up