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Gupta A, Vejapi M, Knezevic NN. The role of nitric oxide and neuroendocrine system in pain generation. Mol Cell Endocrinol 2024; 591:112270. [PMID: 38750811 DOI: 10.1016/j.mce.2024.112270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/13/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Previous studies have indicated a complex interplay between the nitric oxide (NO) pain signaling pathways and hormonal signaling pathways in the body. This article delineates the role of nitric oxide signaling in neuropathic and inflammatory pain generation and subsequently discusses how the neuroendocrine system is involved in pain generation. Hormonal systems including the hypothalamic-pituitary axis (HPA) generation of cortisol, the renin-angiotensin-aldosterone system, calcitonin, melatonin, and sex hormones could potentially contribute to the generation of nitric oxide involved in the sensation of pain. Further research is necessary to clarify this relationship and may reveal therapeutic targets involving NO signaling that alleviate neuropathic and inflammatory pain.
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Affiliation(s)
- Aayush Gupta
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Rosalind Franklin University of Medicine and Science, USA
| | - Maja Vejapi
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA.
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2
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Pan LLH, Chen SP, Ling YH, Wang YF, Lai KL, Liu HY, Chen WT, Huang WJ, Coppola G, Treede RD, Wang SJ. Salivary Testosterone Levels and Pain Perception Exhibit Sex-Specific Association in Healthy Adults But Not in Patients With Migraine. THE JOURNAL OF PAIN 2024; 25:104575. [PMID: 38788888 DOI: 10.1016/j.jpain.2024.104575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/30/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
This study investigated the sex-specific associations between pain perception and testosterone levels in healthy controls (HCs) and patients with migraine. Male and female HCs and migraine patients were recruited. A series of questionnaires were completed by the participants to evaluate their psychosocial profiles, which included data on mood, stress, and sleep quality. Heat pain thresholds and suprathreshold pain ratings at 45 °C (referred to as the pain perception score [PPS]) were assessed using the Thermode system. Salivary testosterone levels were analyzed using a commercial enzyme-linked immunosorbent assay kit. A total of 88 HCs (men/women: 41/47, age: 29.9 ± 7.7 years) and 75 migraine patients (men/women: 30/45, age: 31.1 ± 7.7 years) completed all assessments. No significant differences were observed in either the psychosocial profiles or heat pain thresholds and PPSs between the sexes in the control and migraine groups. A positive correlation between testosterone levels and PPSs was identified in the male controls (r = .341, P = .029), whereas a negative correlation was identified in the female controls (r = -.407, P = .005). No such correlations were identified in the migraine group. This study confirms that a negative association is present between PPSs and testosterone levels in female controls, which is in line with the findings that testosterone is associated with reduced pain perception. Our study is the first to demonstrate a sex-specific association between PPSs and testosterone levels in HCs. Moreover, this study also revealed that the presence of migraine appears to disrupt this association. PERSPECTIVE: This study revealed that testosterone levels demonstrate opposite associations with pain perception in healthy men and women. However, the presence of migraine appears to disrupt this sex-specific association.
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Affiliation(s)
- Li-Ling Hope Pan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shih-Pin Chen
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hsiang Ling
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Feng Wang
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Lin Lai
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hung-Yu Liu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ta Chen
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - William J Huang
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Gianluca Coppola
- Department of Medico‑Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Plumb AN, Lesnak JB, Kolling LJ, Marcinkiewcz CA, Sluka KA. Local Synthesis of Estradiol in the Rostral Ventromedial Medulla Protects against Widespread Muscle Pain in Male Mice. eNeuro 2024; 11:ENEURO.0332-24.2024. [PMID: 39111835 PMCID: PMC11360981 DOI: 10.1523/eneuro.0332-24.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 07/25/2024] [Indexed: 08/30/2024] Open
Abstract
Animal studies consistently demonstrate that testosterone is protective against pain in multiple models, including an animal model of activity-induced muscle pain. In this model, females develop widespread muscle hyperalgesia, and reducing testosterone levels in males results in widespread muscle hyperalgesia. Widespread pain is believed to be mediated by changes in the central nervous system, including the rostral ventromedial medulla (RVM). The enzyme that converts testosterone to estradiol, aromatase, is highly expressed in the RVM. Therefore, we hypothesized that testosterone is converted by aromatase to estradiol locally in the RVM to prevent development of widespread muscle hyperalgesia in male mice. This was tested through pharmacological inhibition of estrogen receptors (ERs), aromatase, or ER-α in the RVM which resulted in contralateral hyperalgesia in male mice (C57BL/6J). ER inhibition in the RVM had no effect on hyperalgesia in female mice. As prior studies show modulation of estradiol signaling alters GABA receptor and transporter expression, we examined if removal of testosterone in males would decrease mRNA expression of GABA receptor subunits and vesicular GABA transporter (VGAT). However, there were no differences in mRNA expression of GABA receptor subunits of VGAT between gonadectomized and sham control males. Lastly, we used RNAscope to determine expression of ER-α in the RVM and show expression in inhibitory (VGAT+), serotonergic (tryptophan hydroxylase 2+), and μ-opioid receptor expressing (MOR+) cells. In conclusion, testosterone protects males from development of widespread hyperalgesia through aromatization to estradiol and activation of ER-α which is widely expressed in multiple cell types in the RVM.
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Affiliation(s)
- Ashley N Plumb
- Departments of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, 52242
| | - Joseph B Lesnak
- Departments of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, 52242
| | - Louis J Kolling
- Neuroscience and Pharmacology, University of Iowa, Iowa City, Iowa, 52242
| | | | - Kathleen A Sluka
- Departments of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, 52242
- Neuroscience and Pharmacology, University of Iowa, Iowa City, Iowa, 52242
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Godley F, Meitzen J, Nahman-Averbuch H, O'Neal MA, Yeomans D, Santoro N, Riggins N, Edvinsson L. How Sex Hormones Affect Migraine: An Interdisciplinary Preclinical Research Panel Review. J Pers Med 2024; 14:184. [PMID: 38392617 PMCID: PMC10889915 DOI: 10.3390/jpm14020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Sex hormones and migraine are closely interlinked. Women report higher levels of migraine symptoms during periods of sex hormone fluctuation, particularly during puberty, pregnancy, and perimenopause. Ovarian steroids, such as estrogen and progesterone, exert complex effects on the peripheral and central nervous systems, including pain, a variety of special sensory and autonomic functions, and affective processing. A panel of basic scientists, when challenged to explain what was known about how sex hormones affect the nervous system, focused on two hormones: estrogen and oxytocin. Notably, other hormones, such as progesterone, testosterone, and vasopressin, are less well studied but are also highlighted in this review. When discussing what new therapeutic agent might be an alternative to hormone therapy and menopause replacement therapy for migraine treatment, the panel pointed to oxytocin delivered as a nasal spray. Overall, the conclusion was that progress in the preclinical study of hormones on the nervous system has been challenging and slow, that there remain substantial gaps in our understanding of the complex roles sex hormones play in migraine, and that opportunities remain for improved or novel therapeutic agents. Manipulation of sex hormones, perhaps through biochemical modifications where its positive effects are selected for and side effects are minimized, remains a theoretical goal, one that might have an impact on migraine disease and other symptoms of menopause. This review is a call to action for increased interest and funding for preclinical research on sex hormones, their metabolites, and their receptors. Interdisciplinary research, perhaps facilitated by a collaborative communication network or panel, is a possible strategy to achieve this goal.
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Affiliation(s)
- Frederick Godley
- Association of Migraine Disorders, P.O. Box 870, North Kingstown, RI 02852, USA
| | - John Meitzen
- Department of Biological Sciences, NC State University, Raleigh, NC 27695, USA
| | - Hadas Nahman-Averbuch
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - David Yeomans
- Department of Anesthesia, Pain and Perioperative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nina Riggins
- Brain Performance Center and Research Institute, San Diego, CA 92122, USA
| | - Lars Edvinsson
- Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University Hospital, 22185 Lund, Sweden
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Henley P, Martins T, Zamani R. Assessing Ethnic Minority Representation in Fibromyalgia Clinical Trials: A Systematic Review of Recruitment Demographics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7185. [PMID: 38131736 PMCID: PMC10742509 DOI: 10.3390/ijerph20247185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
The under-representation of non-White participants in Western countries in clinical research has received increased attention, due to recognized physiological differences between ethnic groups, which may affect the efficacy and optimal dosage of some treatments. This review assessed ethnic diversity in pharmaceutical trials for fibromyalgia, a poorly understood chronic pain disorder. We also investigated longitudinal change to non-White participant proportions in trials and non-White participants' likelihood to discontinue with fibromyalgia research between trial stages (retention). First, we identified relevant trials conducted in the United States and Canada between 2000 and 2022, by searching PubMed, Web of Science, Scopus, and the Cochrane Library databases. In trials conducted both across the United States and Canada, and exclusively within the United States, approximately 90% of participants were White. A longitudinal analysis also found no change in the proportion of non-White participants in trials conducted across the United States and Canada between 2000 and 2022. Finally, we found no significant differences in trial retention between White and non-White participants. This review highlights the low numbers of ethnic minorities in fibromyalgia trials conducted in the United States and Canada, with no change to these proportions over the past 22 years. Furthermore, non-White participants were not more likely to discontinue with the fibromyalgia research once they were recruited.
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Affiliation(s)
| | | | - Reza Zamani
- Medical School, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK (T.M.)
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Karamichali P, Anagnostou T, Kazakos GM, Prassinos N, Dimopoulou I, Savvas I. Effect of gonadectomy on pain assessment in dogs undergoing orthopaedic stifle surgery. Vet Anaesth Analg 2023; 50:430-438. [PMID: 37295978 DOI: 10.1016/j.vaa.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/08/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare pain perception between gonadectomized and intact dogs. STUDY DESIGN Blinded, prospective, cohort study. ANIMALS A group of 74 client-owned dogs. METHODS Dogs were divided into four groups: group 1-female/neutered (F/N), group 2-female/intact (F/I), group 3-male/neutered (M/N) and group 4-male/intact (M/I). Premedication consisted of intramuscularly administered acepromazine (0.05 mg kg-1) and morphine (0.2 mg kg-1), and subcutaneously administered carprofen (4 mg kg-1). Anaesthesia was induced with propofol (1 mg kg-1 intravenously and supplementary doses to effect) and maintained with isoflurane in 100% oxygen. Intraoperative analgesia was achieved with fentanyl infusion (0.1 μg kg-1 minute-1). Pain assessments [using the University of Melbourne Pain Scale (UMPS) and an algometer at the incision site (IS), parallel to the incision site (NIS), and on the contralateral healthy limb] were performed preoperatively, and at 1, 2, 4, 6, 9 and 20 hours after extubation. The time-standardised area under the curve (AUCst) for measurements was calculated and compared by performing a one-way multivariate analysis of variance (manova). Statistical significance was set at p < 0.05. RESULTS Postoperatively, F/N exhibited higher pain than F/I, with estimated marginal means (95% confidence intervals) AUCstISGroup1 909 (672-1146) versus AUCstISGroup2 1385 (1094-1675) (p = 0.014), AUCstNISGroup1 1122 (823-1420) versus AUCstNISGroup2 1668 (1302-2033) (p = 0.024) and AUCstUMPSGroup1 5.30 (4.58-6.02) versus AUCstUMPSGroup2 4.1 (3.2-5.0) (p = 0.041). Similarly, M/N showed higher pain than M/I with AUCstISGroup3 686 (384-987) versus AUCstISGroup4 1107 (871-1345) (p = 0.031) and AUCstNISGroup3 856 (476-1235) versus AUCstNISGroup4 1407 (1109-1706) (p = 0.026), and AUCstUMPSGroup3 6.0 (5.1-6.9) versus AUCstUMPSGroup4 4.4 (3.7-5.2) (p = 0.008). CONCLUSIONS AND CLINICAL RELEVANCE Gonadectomy affects pain sensitivity in dogs undergoing stifle surgery. Neutering status should be taken into consideration when planning individualized anaesthetic/analgesic protocols.
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Affiliation(s)
- Panagiota Karamichali
- Anaesthesiology and Intensive Care Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Tilemachos Anagnostou
- Anaesthesiology and Intensive Care Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Michalis Kazakos
- Anaesthesiology and Intensive Care Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikitas Prassinos
- Surgery & Obstetrics Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irene Dimopoulou
- Anaesthesiology and Intensive Care Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Savvas
- Anaesthesiology and Intensive Care Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lesnak JB, Nakhla DS, Plumb AN, McMillan A, Saha S, Gupta N, Xu Y, Phruttiwanichakun P, Rasmussen L, Meyerholz DK, Salem AK, Sluka KA. Selective androgen receptor modulator microparticle formulation reverses muscle hyperalgesia in a mouse model of widespread muscle pain. Pain 2023; 164:1512-1523. [PMID: 36508167 PMCID: PMC10250561 DOI: 10.1097/j.pain.0000000000002841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
ABSTRACT Chronic pain is a significant health problem associated with disability and reduced quality of life. Current management of chronic pain is inadequate with only modest effects of pharmacological interventions. Thus, there is a need for the generation of analgesics for treating chronic pain. Although preclinical and clinical studies demonstrate the analgesic effects of testosterone, clinical use of testosterone is limited by adverse androgenic effects. Selective androgen receptor modulators (SARMs) activate androgen receptors and overcome treatment limitations by minimizing androgenic side effects. Thus, we tested whether daily soluble SARMs or a SARM-loaded microparticle formulation alleviated muscle hyperalgesia in a mouse-model of widespread pain (male and female C57BL/6J mice). We tested whether the analgesic effects of the SARM-loaded microparticle formulation was mediated through androgen receptors by blocking androgen receptors with flutamide pellets. In vitro and in vivo release kinetics were determined for SARM-loaded microparticles. Safety and toxicity of SARM treatment was determined using serum cardiac and liver toxicity panels, heart histology, and conditioned place preference testing. Subcutaneous daily SARM administration, and 2 injections, 1 week apart, of SARM-loaded microparticles alleviated muscle hyperalgesia in both sexes and was prevented with flutamide treatment. Sustained release of SARM, from the microparticle formulation, was observed both in vitro and in vivo for 4 weeks. Selective androgen receptor modulator treatment produced no cardiac or liver toxicity and did not produce rewarding behaviors. These studies demonstrate that SARM-loaded microparticles, which release drug for a sustained period, alleviate muscle pain, are safe, and may serve as a potential therapeutic for chronic muscle pain.
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Affiliation(s)
- Joseph B. Lesnak
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa; Iowa City, IA
| | - David S. Nakhla
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Ashley N. Plumb
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa; Iowa City, IA
| | - Alexandra McMillan
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Sanjib Saha
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Nikesh Gupta
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Yan Xu
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Pornpoj Phruttiwanichakun
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Lynn Rasmussen
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa; Iowa City, IA
| | | | - Aliasger K. Salem
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Kathleen A. Sluka
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa; Iowa City, IA
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Metabolomic study combined with the low-level light therapy of Chinese acupuncture points and combined oral contraceptives in treatment of primary dysmenorrhea: A prospective, multicenter, randomized controlled study. Heliyon 2023; 9:e13821. [PMID: 36915513 PMCID: PMC10006448 DOI: 10.1016/j.heliyon.2023.e13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Objective To compare the changes of metabolites between Low-level light therapy (LLLT) and combined oral contraceptive (COC) after treatment of primary dysmenorrhea (PD), and to compare and analyze the biological and biochemical effects of the two treatments by analyzing the differences in metabolite profiles. Methods A multicenter, double-blind, prospective, parallel, randomized controlled study was conducted on 69 women aged 16-35 years old with PD who were randomly divided into COC treatment group or LLLT treatment group. Low-level light therapy with light-emitting diodes (LED) was applied on two acupoints named "Guanyuan" (CV4) and "Qihai" (CV6). After 12 weeks of treatment intervention, blood samples were collected before and after treatment for metabolomic analysis. We used UPLC-MS/MS analysis to compare the differences in metabolite changes between LLLT and COC before and after treatment. Results 76 differential metabolites were detected in the LLLT group, and 92 differential metabolites were detected in the COC group, which were up-regulated or down-regulated (p < 0.001). Prostaglandin D2 (PG D2) was down-regulated and biliverdin was up-regulated after LLLT treatment, 4a-Hydroxytetrahydrobiopterin, Prostaglandin D2, 5-Hydroxy-l-tryptophan, Cholic acid were down-regulated and cortisol was up-regulated after COC treatment, and the differences were statistically significant. Cortisol and testosterone glucuronide in LLLT group were significantly lower than those in COC group. The metabolic pathways affected were glycerophospholipid metabolism, linoleic acid metabolism and arachidonic acid metabolism in the LLLT group, and glycerophospholipid metabolism, folate biosynthesis, arachidonic-acid-metabolism, and tryptophan metabolism in the COC group. The differential metabolic pathway were linoleic acid metabolism, steroid hormone biosynthesis, and alpha-Linolenic acid metabolism after the comparison of LLLT with COC. Conclusion LLLT and COC might relieve dysmenorrhea by down-regulating PGD2, and LLLT might also relieve dysmenorrhea by up-regulating biliverdin. The level of cortisol and testosterone glucuronide after LLLT treatment was lower than that after COC treatment, which might lead to the difference in the clinical efficacy of the two treatments for dysmenorrhea.
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Athnaiel O, Cantillo S, Paredes S, Knezevic NN. The Role of Sex Hormones in Pain-Related Conditions. Int J Mol Sci 2023; 24:ijms24031866. [PMID: 36768188 PMCID: PMC9915903 DOI: 10.3390/ijms24031866] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Millions of people are affected by pain-related conditions worldwide. Literature has consistently shown that each individual experiences and perceives pain in a unique manner due to biological, environmental, and cultural factors in which they have been raised. It has been established that biological males and females perceive pain differently and that it may be partially explained by their distinct hormonal profiles since birth, which are only further magnified during puberty. For biological males, high levels of testosterone have shown to increase their pain threshold; and for biological females, estrogen fluctuations have shown to increase pain intensity and perception. However, sex hormones have not been studied in the context of pain treatment or their impact on biochemical pathways involved in pain perception. For this purpose, the transgender community serves as a unique population to investigate the impact of hormone replacement therapy on molecular pathways involved in the perception of pain. The purpose of this review is to explore the biochemistry of hormone replacement in transgender patients who also have other pain-related conditions such as headaches, fibromyalgia, temporomandibular myalgia, and visceral pain.
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Affiliation(s)
- Onella Athnaiel
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
| | - Santiago Cantillo
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Stephania Paredes
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
- Correspondence:
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Lesnak JB, Fahrion A, Helton A, Rasmussen L, Andrew M, Cunard S, Huey M, Kreber A, Landon J, Siwiec T, Todd K, Frey-Law LA, Sluka KA. Resistance training protects against muscle pain through activation of androgen receptors in male and female mice. Pain 2022; 163:1879-1891. [PMID: 35353765 PMCID: PMC9481652 DOI: 10.1097/j.pain.0000000000002638] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Resistance training-based exercise is commonly prescribed in the clinic for the treatment of chronic pain. Mechanisms of aerobic exercise for analgesia are frequently studied, while little is known regarding resistance training mechanisms. We developed a resistance training model in mice and hypothesized resistance training would protect against development of muscle pain, mediated through the activation of androgen receptors. Activity-induced muscle hyperalgesia was produced by 2 injections of pH 5.0 stimuli with fatiguing muscle contractions. Resistance training was performed by having mice climb a ladder with attached weights, 3 times per week. Resistance training acutely increased blood lactate and prolonged training increased strength measured via forepaw grip strength and 1 repetition maximum, validating the exercise program as a resistance training model. Eight weeks of resistance training prior to induction of the pain model blocked the development of muscle hyperalgesia in both sexes. Resistance training initiated after induction of the pain model reversed muscle hyperalgesia in male mice only. A single resistance training bout acutely increased testosterone in male but not female mice. Administration of the androgen receptor antagonist flutamide (200 mg pellets) throughout the 8-week training program blocked the exercise-induced protection against muscle pain in both sexes. However, single administration of flutamide (1, 3, 10 mg/kg) in resistance-trained animals had no effect on existing exercise-induced protection against muscle pain. Therefore, resistance training acutely increases lactate and testosterone and strength overtime. Eight weeks of resistance training prevents the development of hyperalgesia through the activation of androgen receptors in an animal model of muscle pain.
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Affiliation(s)
- Joseph B. Lesnak
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Alexis Fahrion
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Amber Helton
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Lynn Rasmussen
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Megan Andrew
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Stefanie Cunard
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Michaela Huey
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Austin Kreber
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Joseph Landon
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Travis Siwiec
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Kenan Todd
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Laura A. Frey-Law
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Kathleen A. Sluka
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
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11
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Metyas S, Chen C, Joseph M, Hanna N, Basta J, Khalil A. Subcategories of Fibromyalgia: A New Concept. Curr Rheumatol Rev 2022; 18:18-25. [PMID: 35220935 DOI: 10.2174/2666255815666220225103234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/03/2021] [Accepted: 11/24/2021] [Indexed: 02/08/2023]
Abstract
Fibromyalgia has previously been categorized as primary, secondary, and juvenile fibromyalgia. However, these definitions do not adequately explain the etiopathology of disease, nor do they help direct new specific therapies. Herein, we review the previously known categorizations of fibromyalgia. Based on common patient characteristics and previously studied pathophysiologies, we propose new subcategorizations of fibromyalgia that we have self-narrated, including hormonal fibromyalgia, neuroendocrine fibromyalgia, psychologic fibromyalgia, inflammatory fibromyalgia, and lastly, neuropathic fibromyalgia. Future research needs to be done to verify, add to, and fully describe these self-narrated categories of fibromyalgia that we have proposed.
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Affiliation(s)
- Samy Metyas
- Covina Arthritis Clinic, Covina, California, CA, USA
| | | | - Marina Joseph
- Covina Arthritis Clinic, Covina, California, CA, USA
| | | | - Joseph Basta
- Covina Arthritis Clinic, Covina, California, CA, USA
| | - Andrew Khalil
- Covina Arthritis Clinic, Covina, California, CA, USA
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12
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Biological sex, by-products, and other continuous variables. Behav Brain Sci 2022; 45:e144. [PMID: 35875948 DOI: 10.1017/s0140525x22000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sex/gender is a continuous variable that researchers frequently treat as dichotomous. This practice can mask continuous underlying adaptive traits and yield spurious dichotomous "sex differences." As such, many sex differences in self-protection may be evolutionary by-products of underlying adaptations rather than adaptations themselves. Binary analysis of continuous sex/gender is ill-considered science that can contribute to inequality and counterproductive public policy.
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13
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Evans SF, Hull ML, Hutchinson MR, Rolan PE. Androgens, Endometriosis and Pain. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:792920. [PMID: 36303965 PMCID: PMC9580713 DOI: 10.3389/frph.2021.792920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/11/2021] [Indexed: 01/04/2023] Open
Abstract
The intriguing relationship between androgens, endometriosis and chronic pain continues to unfold. Determining this relationship is of crucial importance to gynecologists managing people with these conditions, as common treatments dramatically alter her hormonal profiles, with both intended and unintended consequences. Although they may be present in the same individual, there is a recognized disconnect between pain or pain-related symptoms, and the presence or extent of endometriosis lesions. Reduced androgen levels provide a potential mechanism to link the development of endometriosis lesions and the presence of chronic pain. This research paper expands the presentation of our research at the World Endometriosis Congress in 2021, subsequently published in the Journal of Pain Research which demonstrated a strong inverse relationship between androgen levels and days per month of pelvic and period pain. Here we extend and further explore the evidence for a role for androgens in the etiology and management of dysmenorrhea and pelvic pain in women, both with and without endometriosis. We explore the potential for inflammation to induce low androgen levels and consider ways in which clinicians can optimize levels of androgens when treating women with these conditions. This article prompts the question: Is it estrogens that predispose people to a life of pain, or androgens that are protective?
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Affiliation(s)
- Susan F. Evans
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Susan F. Evans
| | - M. Louise Hull
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
| | - Mark R. Hutchinson
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of Adelaide, Adelaide, SA, Australia
| | - Paul E. Rolan
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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14
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Lunenfeld B, Mskhalaya G, Zitzmann M, Corona G, Arver S, Kalinchenko S, Tishova Y, Morgentaler A. Recommendations on the diagnosis, treatment and monitoring of testosterone deficiency in men. Aging Male 2021; 24:119-138. [PMID: 34396893 DOI: 10.1080/13685538.2021.1962840] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age globally. One in four persons living in Europe and Northern America will be aged 65 or over. One of the goals of ISSAM is to raise awareness of the special health needs of older men. Since a significant number of aging men will eventually become testosterone deficient, the Hypogonadism panel of ISSAM updates its guidelines.
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Affiliation(s)
- Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | | | - Michael Zitzmann
- Center for Reproductive Medicine and Andrology/Clinical and Surgical Andrology, University Hospital of Münster, Münster, Germany
| | - Giovanni Corona
- Medical Department, Endocrinology Unit, Maggiore Bellaria Hospital, Bologna, Italy
| | - Stefan Arver
- Department of Medicine/Huddinge Karolinska Institutet and ANOVA, Karolinska University Hospital, Stockholm, Sweden
| | - Svetlana Kalinchenko
- Department of Endocrinology, People's Friendship University of Russia, Moscow, Russia
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15
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Ozcivit IB, Erel CT, Durmusoglu F. Can fibromyalgia be considered a characteristic symptom of climacterium? Postgrad Med J 2021; 99:postgradmedj-2021-140336. [PMID: 34373344 DOI: 10.1136/postgradmedj-2021-140336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic pain syndrome, characterised by diffuse pain in musculoskeletal system and accompanied by stiffness, fatigue, tender points, sleep disturbances and cognitive and gastrointestinal symptoms. It affects middle-aged women (between 40 and 65) predominantly. Climacteric syndrome, which is characterised by vasomotor, somatic (headache, sleep disorders, myalgia and arthralgia) and psychical (mood changes) symptoms, results from the change in brain neurotransmitter concentrations due to gradual decline of ovarian hormone levels. Currently, studies focus on the similarities of FMS and climacteric syndrome in terms of age of occurrence, epidemiology, etiopathogenesis, symptomatology and treatment. Hormonal fluctuation during menopausal transition is likely the triggering factor for both syndromes. Therefore, hormone replacement therapy is a favourable approach in the treatment of FMS due to the antiallodynic, anti-inflammatory and neuroprotective effect of oestrogen. In this review, we emphasise the similarity of FMS and climacteric syndrome and suggested that FMS could be considered as a characteristic symptom of climacterium.
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Affiliation(s)
- Ipek Betul Ozcivit
- Obstetrics and Gynecology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Turkey
| | - Cemal Tamer Erel
- Obstetrics and Gynecology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Turkey
| | - Fatih Durmusoglu
- Department of Obstetrics and Gynecology, Istanbul Medipol University, Istanbul, Turkey
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16
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Carrera Arias FJ, Aenlle K, Abreu M, Holschbach MA, Michalovicz LT, Kelly KA, Klimas N, O’Callaghan JP, Craddock TJA. Modeling Neuroimmune Interactions in Human Subjects and Animal Models to Predict Subtype-Specific Multidrug Treatments for Gulf War Illness. Int J Mol Sci 2021; 22:ijms22168546. [PMID: 34445252 PMCID: PMC8395153 DOI: 10.3390/ijms22168546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/03/2023] Open
Abstract
Gulf War Illness (GWI) is a persistent chronic neuroinflammatory illness exacerbated by external stressors and characterized by fatigue, musculoskeletal pain, cognitive, and neurological problems linked to underlying immunological dysfunction for which there is no known treatment. As the immune system and the brain communicate through several signaling pathways, including the hypothalamic–pituitary–adrenal (HPA) axis, it underlies many of the behavioral and physiological responses to stressors via blood-borne mediators, such as cytokines, chemokines, and hormones. Signaling by these molecules is mediated by the semipermeable blood–brain barrier (BBB) made up of a monocellular layer forming an integral part of the neuroimmune axis. BBB permeability can be altered and even diminished by both external factors (e.g., chemical agents) and internal conditions (e.g., acute or chronic stress, or cross-signaling from the hypothalamic–pituitary–gonadal (HPG) axis). Such a complex network of regulatory interactions that possess feed-forward and feedback connections can have multiple response dynamics that may include several stable homeostatic states beyond normal health. Here we compare immune and hormone measures in the blood of human clinical samples and mouse models of Gulf War Illness (GWI) subtyped by exposure to traumatic stress for subtyping this complex illness. We do this via constructing a detailed logic model of HPA–HPG–Immune regulatory behavior that also considers signaling pathways across the BBB to neuronal–glial interactions within the brain. We apply conditional interactions to model the effects of changes in BBB permeability. Several stable states are identified in the system beyond typical health. Following alignment of the human and mouse blood profiles in the context of the model, mouse brain sample measures were used to infer the neuroinflammatory state in human GWI and perform treatment simulations using a genetic algorithm to optimize the Monte Carlo simulations of the putative treatment strategies aimed at returning the ill system back to health. We identify several ideal multi-intervention strategies and potential drug candidates that may be used to treat chronic neuroinflammation in GWI.
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Affiliation(s)
- Francisco J. Carrera Arias
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
| | - Kristina Aenlle
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Miami Veterans Affairs Healthcare System, Miami, FL 33125, USA
| | - Maria Abreu
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Miami Veterans Affairs Healthcare System, Miami, FL 33125, USA
| | - Mary A. Holschbach
- Department of Psychology & Neuroscience, College of Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
| | - Lindsay T. Michalovicz
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA; (L.T.M.); (K.A.K.); (J.P.O.)
| | - Kimberly A. Kelly
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA; (L.T.M.); (K.A.K.); (J.P.O.)
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Miami Veterans Affairs Healthcare System, Miami, FL 33125, USA
| | - James P. O’Callaghan
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA; (L.T.M.); (K.A.K.); (J.P.O.)
| | - Travis J. A. Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Department of Psychology & Neuroscience, College of Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
- Department of Computer Science, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Correspondence: ; Tel.: +1-954-262-2868
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17
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Abstract
Chronic widespread pain conditions are more prevalent in women than men, suggesting a role for gonadal hormones in the observed differences. Previously, we showed that female mice, compared to male, develop widespread, more severe, and longer-duration hyperalgesia in a model of activity-induced muscle pain. We hypothesized testosterone protects males from developing the female pain phenotype. We tested whether orchiectomy of males before induction of an activity-induced pain model produced a female phenotype and whether testosterone administration produced a male phenotype in females. Orchiectomy produced longer-lasting, more widespread hyperalgesia, similar to females. Administration of testosterone to females or orchiectomized males produced unilateral, shorter-lasting hyperalgesia. Prior studies show that the serotonin transporter (SERT) is increased in the nucleus raphe magnus (NRM) in models of chronic pain, and that blockade of SERT in the NRM reduces hyperalgesia. We examined potential sex differences in the distribution of SERT across brain sites involved in nociceptive processing using immunohistochemistry. A sex difference in SERT was found in the NRM in the activity-induced pain model; females had greater SERT immunoreactivity than males. This suggests that testosterone protects against development of widespread, long-lasting muscle pain and that alterations in SERT may underlie the sex differences.
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18
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Evans SF, Kwok Y, Solterbeck A, Pyragius C, Hull ML, Hutchinson MR, Rolan P. The Relationship Between Androgens and Days per Month of Period Pain, Pelvic Pain, Headache, and TLR4 Responsiveness of Peripheral Blood Mononuclear Cells in Young Women with Dysmenorrhoea. J Pain Res 2021; 14:585-599. [PMID: 33688248 PMCID: PMC7937378 DOI: 10.2147/jpr.s279253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/07/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose Women bear a disproportionate burden of persistent pain conditions when compared to men. To determine whether the hormonal environment affects the clinical experience of pain, as measured by the days per month of pelvic pain (DPelvicPM), period pain (DPeriodPM), headache (DHeadachePM) or the in vitro EC50 for Interleukin-1β (IL-1β) release following TLR4 stimulation with Lipopolysaccharide from Peripheral Blood Mononuclear Cells (PBMCs). Findings were stratified according to use or non-use of the oral contraceptive pill. Patients and Methods Fifty-six women aged 16–35 years, with minimal or severe dysmenorrhea, and use or non-use of the OC, were enrolled. Blood was collected on two occasions in a single menstrual cycle: Days 1–2 and Days 7–10. Hormonal analysis for testosterone, dihydrotestosterone, dehydroepiandrosterone, Androstenedione, 3α-Androstanediol, 3β-androstanediol, estradiol, estrone, 17α-hydroxyprogesterone, progesterone, cortisol and sex-hormone binding globulin was undertaken using ultra-sensitive Liquid Chromatography Mass–Spectrometry (LC-MS). PBMCs were exposed to lipopolysaccharide (LPS) and the resulting Interleukin-1β output was determined. Results Non-users of the OC showed a strongly inverse correlation between a reducing free androgen index (FAI) and increasing DPelvicPM (p=0.0032), DPeriodPM (p=0.013), DHeadachePM (p=0.041). Non-users of the OC showed a significant increase in DPelvicPM (p=0.049) on Days 7–10. Modestly significant associations were found between reduced androgens and potentiated LPS-induced IL-1β (lower EC50). Conclusion This is the first study to investigate the relationship between the hormonal environment and activation of the immune system in young women with dysmenorrhoea-related pain conditions. Low androgen levels were consistently associated with increased pain. Translational implications for the findings are discussed.
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Affiliation(s)
- Susan F Evans
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Yuen Kwok
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Carmen Pyragius
- School of Paediatrics & Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Mary Louise Hull
- Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark R Hutchinson
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,ARC Centre of Excellence for Nanoscale Biophotonics, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Rolan
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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19
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Macchia D, Lippi D, Bianucci R, Donell S. President John F Kennedy’s medical history: coeliac disease and autoimmune polyglandular syndrome type 2. Postgrad Med J 2020; 96:543-549. [DOI: 10.1136/postgradmedj-2020-137722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Abstract
President John F. Kennedy (JFK) had a complex medical history that is now thought to be an autoimmune polyglandular syndrome type 2 with Addison’s disease and hypothyroidism. He also had gastrointestinal symptoms from adolescence, which now fit well with coeliac disease. In addition, he had a chronic back problem, which contributed to a chronic pain syndrome. This review looks at JFK’s various diseases and focusses on the history of coeliac disease, as well as its presentation. JFK’s Irish ancestry supports the hypothesis of a coeliac disease started early in his youth.
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20
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Kato Y, Shigehara K, Kawaguchi S, Izumi K, Kadono Y, Mizokami A. Efficacy of testosterone replacement therapy on pain in hypogonadal men with chronic pain syndrome: A subanalysis of a prospective randomised controlled study in Japan (EARTH study). Andrologia 2020; 52:e13768. [DOI: 10.1111/and.13768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/10/2020] [Accepted: 06/28/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Yuki Kato
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
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21
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Maseroli E, Vignozzi L. Testosterone and Vaginal Function. Sex Med Rev 2020; 8:379-392. [DOI: 10.1016/j.sxmr.2020.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 01/04/2023]
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22
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Meester I, Rivera-Silva GF, González-Salazar F. Immune System Sex Differences May Bridge the Gap Between Sex and Gender in Fibromyalgia. Front Neurosci 2020; 13:1414. [PMID: 32009888 PMCID: PMC6978848 DOI: 10.3389/fnins.2019.01414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
The fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, sleep disturbances, fatigue, and cognitive alterations. A limited efficacy of targeted treatment and a high FMS prevalence (2–5% of the adult population) sums up to high morbidity. Although, altered nociception has been explained with the central sensitization hypothesis, which may occur after neuropathy, its molecular mechanism is not understood. The marked female predominance among FMS patients is often attributed to a psychosocial predisposition of the female gender, but here we will focus on sex differences in neurobiological processes, specifically those of the immune system, as various immunological biomarkers are altered in FMS. The activation of innate immune sensors is compatible with a neuropathy or virus-induced autoimmune diseases. Considering sex differences in the immune system and the clustering of FMS with autoimmune diseases, we hypothesize that the female predominance in FMS is due to a neuropathy-induced autoimmune pathophysiology. We invite the scientific community to verify the autoimmune hypothesis for FMS.
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Affiliation(s)
- Irene Meester
- Laboratory of Tissue Engineering and Regenerative Medicine, Basic Sciences Department, University of Monterrey, San Pedro Garza García, Mexico
| | - Gerardo Francisco Rivera-Silva
- Laboratory of Tissue Engineering and Regenerative Medicine, Basic Sciences Department, University of Monterrey, San Pedro Garza García, Mexico
| | - Francisco González-Salazar
- Laboratory of Tissue Engineering and Regenerative Medicine, Basic Sciences Department, University of Monterrey, San Pedro Garza García, Mexico.,Laboratory of Cellular Physiology, Northeast Center of Research, Mexican Institute of Social Security, Monterrey, Mexico
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Singh L, Kaur A, Bhatti MS, Bhatti R. Possible Molecular Mediators Involved and Mechanistic Insight into Fibromyalgia and Associated Co-morbidities. Neurochem Res 2019; 44:1517-1532. [PMID: 31004261 DOI: 10.1007/s11064-019-02805-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 12/12/2022]
Abstract
Fibromyalgia is a chronic complex syndrome of non-articulate origin characterized by musculoskeletal pain, painful tender points, sleep problems and co-morbidities including depression, migraine. The etiopathogenesis of fibromyalgia is complex, variable and remains inconclusive. The etiological factors that have been defined include stress, genetic predisposition and environmental components. As per the reports of the American College of Rheumatology (ACR) the prevalence of fibromyalgia varies from 2 to 22% among the general population with poor diagnostic features primarily pain. Fibromyalgia encompasses a spectrum of co-morbid conditions with multifarious pathogenesis. The highly prevalent manifestations of fibromyalgia include heterogeneous pain and aches. Biochemical and neurobiological elements of fibromyalgia include neurotransmitters, hypothalamic pituitary adrenal axis (HPA axis), inflammatory cytokines, monoaminergic pathway, opioid peptides, sex hormones, nerve growth factor (NGF) and local free radical insult. An imbalance in the serotonergic system is the major underlying etiological factor that has been explored most widely. Owing to complex interplay of diverse pathophysiological pathways, overlapping co-morbidities such as depression have been clinically observed. Therapeutic management of fibromyalgia involves both non pharmacological and pharmacological measures. The current review presents various dysregulations and their association with symptoms of fibromyalgia along with their underlying neurobiological aspects.
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Affiliation(s)
- Lovedeep Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Anudeep Kaur
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Manpreet S Bhatti
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Rajbir Bhatti
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, India.
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25
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Archey M, Goldey K, Crockett E, Boyette-Davis J. An Investigation of the Effects of Testosterone and Behavioral Expressions of Pain on Sex/Gender Differences in Pain Perception. Psychol Rep 2018; 122:826-840. [DOI: 10.1177/0033294118781320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Research indicates that women are more susceptible to pain than men, but the reason for this difference is unclear. While estrogen and progesterone have been implicated, testosterone has not received adequate consideration in the literature. Additionally, incorporating behavioral expressions, or exaggerations, of pain as an important aspect of pain perception is receiving increasing attention. The current study examined the role of testosterone in female pain expression and perception via the cold pressor test. Following all participant exclusions, 46 healthy participants (32 women) provided saliva samples for testosterone analysis using enzyme-linked immunosorbent assay before and after rating their pain during the cold pressor test. Participants used a visual analog scale to indicate how the 2℃ water was perceived, ranging from “worst pain imaginable” to “no pain.” The researcher also noted whether a participant displayed overt behavioral expressions of pain such as jumping and cursing. The results revealed that men reported lower visual analog scale scores than women, indicating less perceived pain. A subgroup of women who displayed overt behavioral responses to pain seemed to be driving this sex/gender difference. It was expected that this subgroup of females would have corresponding changes in testosterone that would further explain the observed sex/gender differences, but this was not supported. Collectively, these data add to the previous literature investigating sex/gender differences in pain perception and highlight the importance of studying overt behavioral expressions of pain. Testosterone may alter this behavior and subsequent pain perception, but the contributions of testosterone are likely subtle and were not detected in this study.
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Affiliation(s)
- Meggan Archey
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Katherine Goldey
- Department of Psychology and Behavioral Neuroscience, St. Edward’s University, Austin, TX, USA
| | - Erin Crockett
- Department of Psychology, Southwestern University, Georgetown, TX, USA
| | - Jessica Boyette-Davis
- Department of Psychology and Behavioral Neuroscience, St. Edward’s University, Austin, TX, USA
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26
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Traish AM, Vignozzi L, Simon JA, Goldstein I, Kim NN. Role of Androgens in Female Genitourinary Tissue Structure and Function: Implications in the Genitourinary Syndrome of Menopause. Sex Med Rev 2018; 6:558-571. [PMID: 29631981 DOI: 10.1016/j.sxmr.2018.03.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Genitourinary conditions in women increase in prevalence with age. Androgens are prerequisite hormones of estrogen biosynthesis, are produced in larger amounts than estrogens in women, and decrease throughout adulthood. However, research and treatment for genitourinary complaints have traditionally focused on estrogens to the exclusion of other potential hormonal influences. AIM To summarize and evaluate the evidence that androgens are important for maintaining genitourinary health in women and that lack of androgenic activity can contribute to the development of symptoms of the genitourinary syndrome of menopause. METHODS The role of androgens in the pathophysiology, diagnosis, and treatment of genitourinary syndrome of menopause was discussed by an international and multidisciplinary panel during a consensus conference organized by the International Society for the Study of Women's Sexual Health. A subgroup further examined publications from the PubMed database, giving preference to clinical studies or to basic science studies in human tissues. MAIN OUTCOME MEASURES Expert opinion evaluating trophic and functional effects of androgens, their differences from estrogenic effects, and regulation of androgen and estrogen receptor expression in female genitourinary tissues. RESULTS Androgen receptors have been detected throughout the genitourinary system using immunohistochemical, western blot, ligand binding, and gene expression analyses. Lower circulating testosterone and estradiol concentrations and various genitourinary conditions have been associated with differential expression of androgen and estrogen receptors. Supplementation of androgen and/or estrogen in postmenopausal women (local administration) or in ovariectomized animals (systemic administration) induces tissue-specific responses that include changes in androgen and estrogen receptor expression, cell growth, mucin production, collagen turnover, increased perfusion, and neurotransmitter synthesis. CONCLUSION Androgens contribute to the maintenance of genitourinary tissue structure and function. The effects of androgens can be distinct from those of estrogens or can complement estrogenic action. Androgen-mediated processes might be involved in the full or partial resolution of genitourinary syndrome of menopause symptoms in women. Traish AM, Vignozzi L, Simon JA, et al. Role of Androgens in Female Genitourinary Tissue Structure and Function: Implications in the Genitourinary Syndrome of Menopause. Sex Med Rev 2018;6:558-571.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
| | - Linda Vignozzi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - James A Simon
- Women's Health & Research Consultants, Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA
| | | | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA.
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Hernandez-Leon A, De la Luz-Cuellar YE, Granados-Soto V, González-Trujano ME, Fernández-Guasti A. Sex differences and estradiol involvement in hyperalgesia and allodynia in an experimental model of fibromyalgia. Horm Behav 2018; 97:39-46. [PMID: 29080671 DOI: 10.1016/j.yhbeh.2017.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/21/2017] [Accepted: 10/24/2017] [Indexed: 01/04/2023]
Abstract
Fibromyalgia (FM) is a musculoskeletal chronic pain syndrome. Its prevalence in women is higher than in men possibly by hormonal factors given that symptoms are aggravated during sex hormone-related events, such as the premenstrual period, pregnancy, postpartum or menopause. The aim of the present study was to investigate whether hyperalgesia and allodynia, in reserpine-induced experimental FM, depend on sex, estrous cycle, ovariectomy and replacement with 17β-estradiol. To fulfill this objective, we compared males, intact females with known estrous cycle phases and ovariectomized (OVX) rats treated with 17β-estradiol. Data demonstrated that reserpine administration disrupted the normal estrous cycle and produced that all females entered metestrus/diestrus. In addition, this treatment leads to muscle hyperalgesia and tactile allodynia in a similar manner in male and intact female rats. However, the absence of ovarian hormones (in OVX rats) increased muscle nociception. 17β-estradiol (2.5-10μg/rat) produced antihyperalgesic and antiallodynic effects 24h, but not 8h, after its administration, suggesting a genomic mechanism. The present results support the validity of the reserpine-induced FM model for searching alternatives of treatment, particularly during endocrine phases when pain is exacerbated such as menopause, and that 17β-estradiol replacement might be useful.
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Affiliation(s)
- Alberto Hernandez-Leon
- Departamento de Farmacobiología, Cinvestav, Unidad Coapa, Calz. De los Tenorios 235, Col. Granjas Coapa, 14330 Mexico City, Mexico; Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz. México-Xochimilco 101, Col. San Lorenzo, Huipulco, 14370 Mexico City, Mexico
| | - Yarim Elideth De la Luz-Cuellar
- Departamento de Farmacobiología, Cinvestav, Unidad Coapa, Calz. De los Tenorios 235, Col. Granjas Coapa, 14330 Mexico City, Mexico
| | - Vinicio Granados-Soto
- Departamento de Farmacobiología, Cinvestav, Unidad Coapa, Calz. De los Tenorios 235, Col. Granjas Coapa, 14330 Mexico City, Mexico
| | - María Eva González-Trujano
- Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz. México-Xochimilco 101, Col. San Lorenzo, Huipulco, 14370 Mexico City, Mexico
| | - Alonso Fernández-Guasti
- Departamento de Farmacobiología, Cinvestav, Unidad Coapa, Calz. De los Tenorios 235, Col. Granjas Coapa, 14330 Mexico City, Mexico.
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Schertzinger M, Wesson-Sides K, Parkitny L, Younger J. Daily Fluctuations of Progesterone and Testosterone Are Associated With Fibromyalgia Pain Severity. THE JOURNAL OF PAIN 2017; 19:410-417. [PMID: 29248511 DOI: 10.1016/j.jpain.2017.11.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 11/09/2017] [Accepted: 11/28/2017] [Indexed: 02/07/2023]
Abstract
The purpose of this longitudinal blood sampling study was to examine relationships between sex hormones and fibromyalgia pain. Eight women meeting case definition criteria for fibromyalgia provided venous blood samples and reported their fibromyalgia pain severity over 25 consecutive days. All women exhibited normal menstrual cycles and were not taking oral contraceptives. Cortisol, and the sex hormones estradiol, progesterone, and testosterone, were assayed from serum. A linear mixed model was used to determine if fluctuations of sex hormones were associated with changes in pain severity. In the entire sample, day to day changes in progesterone (P = .002) as well as testosterone (P = .015) were significantly and inversely correlated with pain severity. There was no relationship between estradiol and pain (P = .551) or cortisol and pain (P = .633). These results suggest that progesterone and testosterone play a protective role in fibromyalgia pain severity. Sex and other hormones may serve to increase as well as decrease fibromyalgia pain severity. PERSPECTIVE Sex hormones fluctuate normally in women with fibromyalgia, but may still contribute to pain severity.
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Affiliation(s)
| | - Kate Wesson-Sides
- University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama
| | - Luke Parkitny
- University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama
| | - Jarred Younger
- University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama.
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Danilov AB, Ilyasov RR. Sex hormones and pain. Zh Nevrol Psikhiatr Im S S Korsakova 2017. [DOI: 10.17116/jnevro201711721149-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gerardi MC, Batticciotto A, Talotta R, Di Franco M, Atzeni F, Sarzi-Puttini P. Novel pharmaceutical options for treating fibromyalgia. Expert Rev Clin Pharmacol 2016; 9:559-565. [DOI: 10.1586/17512433.2016.1145052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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