Reduced reactivity and enhanced negative feedback sensitivity of the hypothalamus-pituitary-adrenal axis in chronic whiplash-associated disorder

Pain. 2005 Dec 15;119(1-3):219-224. doi: 10.1016/j.pain.2005.10.001. Epub 2005 Nov 17.


Dysregulations of the hypothalamus-pituitary-adrenal (HPA) axis have been discussed as a physiological substrate of chronic pain and fatigue. The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash-associated disorder (WAD). In 20 patients with chronic WAD and 20 healthy controls, awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5mg dexamethasone. In comparison to the controls, chronic WAD patients had attenuated cortisol responses to awakening, normal cortisol levels during the day, and showed enhanced and prolonged suppression of cortisol after the administration of 0.5mg dexamethasone. Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD. The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Chronic Disease
  • Dexamethasone
  • Feedback / drug effects
  • Female
  • Humans
  • Hydrocortisone / analysis*
  • Hypothalamo-Hypophyseal System / drug effects
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Male
  • Middle Aged
  • Neck Pain / complications
  • Neck Pain / diagnosis*
  • Neck Pain / physiopathology*
  • Pituitary-Adrenal System / drug effects
  • Pituitary-Adrenal System / physiopathology*
  • Saliva / chemistry*
  • Sensitivity and Specificity
  • Whiplash Injuries / complications
  • Whiplash Injuries / diagnosis*
  • Whiplash Injuries / physiopathology*


  • Dexamethasone
  • Hydrocortisone