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Sex Hormones and Pain: The Evidence From Functional Imaging

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Abstract

There is a substantial body of epidemiological and clinical evidence suggesting that the sex hormones, particularly estradiol and progesterone, play a role in pain. Behavioral studies have not been useful in understanding the relationship between sex hormones and pain perception, and certainly have not helped to elucidate the mechanisms by which such effects may be mediated. This review aims to address the additional insights functional imaging has given us into the role of sex hormones in pain. Functional imaging techniques and experimental designs are discussed before the literature investigating specific questions relating to hormones and pain is reviewed. Finally, we conclude by considering how results of studies imaging the influence of sex hormones in related areas such as emotion and cognition also may inform our understanding of this complex area.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. LeResche L, Mancl LA, Drangsholt MT, et al.: Relationship of pain and symptoms to pubertal development in adolescents. Pain 2005, 118:201–209.

    Article  PubMed  Google Scholar 

  2. Unruh AM: Gender variations in clinical pain experience. Pain 1996, 65:123–167.

    Article  CAS  PubMed  Google Scholar 

  3. LeResche L: Epidemiologic perspectives on sex differences in pain. In Sex, Gender and Pain. Progress in Pain Research and Management, vol 17. Edited by Fillingim RB. Seattle: IASP Press; 2000:233–249.

    Google Scholar 

  4. Lentz GM, Bavendam T, Stenchever MA, et al.: Hormonal manipulation in women with chronic, cyclic irritable bladder symptoms and pelvic pain. Am J Obstet Gynecol 2002, 186:1268–1271.

    Article  CAS  PubMed  Google Scholar 

  5. Martin V, Wernke S, Mandell K, et al.: Medical oophorectomy with and without estrogen add-back therapy in the prevention of migraine headache. Headache 2003, 43:309–321.

    Article  PubMed  Google Scholar 

  6. Mathias JR, Clench MH, Reeves-Darby VG, et al.: Effect of leuprolide acetate in patients with moderate to severe functional bowel disease. Double-blind, placebo-controlled study. Dig Dis Sci 1994, 39:1155–1162.

    Article  CAS  PubMed  Google Scholar 

  7. Sherman JJ, LeResche L: Does experimental pain response vary across the menstrual cycle? A methodological review. Am J Physiol Regul Integr Comp Physiol 2006, 291:R245–256.

    CAS  PubMed  Google Scholar 

  8. Le Mellédo JM, Baker G: Role of progesterone and other neuroactive steroids in anxiety disorders. Expert Rev Neurother 2004, 4:851–860.

    Article  PubMed  Google Scholar 

  9. Steiner M, Dunn E, Born L: Hormones and mood: from menarche to menopause and beyond. J Affect Disord 2003, 74:67–83.

    Article  CAS  PubMed  Google Scholar 

  10. • Johnson MH: Essential Reproduction, edn 6. Oxford: Blackwell Publishing; 2007. This textbook is an excellent introduction to reproductive physiology and endocrinology.

    Google Scholar 

  11. Aloisi AM, Bonifazi M: Sex hormones, central nervous system and pain. Horm Behav 2006, 50:1–7.

    Article  CAS  PubMed  Google Scholar 

  12. Roglio I, Bianchi R, Gotti S, et al.: Neuroprotective effects of dihydroprogesterone and progesterone in an experimental model of nerve crush injury. Neuroscience 2008, 155:673–685.

    Article  CAS  PubMed  Google Scholar 

  13. Puri V, Puri S, Svojanovsky SR, et al.: Effects of oestrogen on trigeminal ganglia in culture: implications for hormonal effects on migraine. Cephalalgia 2006, 26:33–42.

    Article  CAS  PubMed  Google Scholar 

  14. Schuurs AH, Verheul HA: Effects of gender and sex steroids on the immune response. J Steroid Biochem 1990, 35:157–172.

    Article  CAS  PubMed  Google Scholar 

  15. Storer TW, Woodhouse L, Magliano L, et al.: Changes in muscle mass, muscle strength, and power but not physical function are related to testosterone dose in healthy older men. J Am Geriatr Soc 2008, 56:1991–1999.

    Article  PubMed  Google Scholar 

  16. Traupe T, Stettler CD, Li H, et al.: Distinct roles of estrogen receptors alpha and beta mediating acute vasodilation of epicardial coronary arteries. Hypertension 2007, 49:1364–1370.

    Article  CAS  PubMed  Google Scholar 

  17. Asarian L, Geary N: Modulation of appetite by gonadal steroid hormones. Philos Trans R Soc Lond B Biol Sci 2006, 361:1251–1263.

    Article  CAS  PubMed  Google Scholar 

  18. Alliende ME: Mean versus individual hormonal profiles in the menstrual cycle. Fertil Steril 2002, 78:90–95.

    Article  PubMed  Google Scholar 

  19. Ferrer J, Mtnez-Guisasola J, Díaz F, et al.: Plasma levels of beta-endorphin during the menstrual cycle. Gynecol Endocrinol 1997, 11:75–82.

    Article  CAS  PubMed  Google Scholar 

  20. •• Craft RM: Modulation of pain by estrogens. Pain 2007, 132(Suppl 1):S3–S12. This review covers both animal and human studies investigating the influence of estrogens on pain.

    Article  CAS  PubMed  Google Scholar 

  21. • Aloisi AM, Bachiocco V, Costantino A, et al.: Cross-sex hormone administration changes pain in transsexual women and men. Pain 2007, 132(Suppl 1):S60–S67. This paper presents intriguing results from a study that would not be ethically possible to replicate in any other cohort.

    Article  CAS  PubMed  Google Scholar 

  22. •• Fillingim RB, King CD, Ribeiro-Dasilva MC, et al.: Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009, 10:447–485. This is a very detailed review of the experimental and clinical evidence supporting an effect of sex and gender on pain.

    Article  PubMed  Google Scholar 

  23. Cooke B, Hegstrom CD, Villeneuve LS, Breedlove SM: Sexual differentiation of the vertebrate brain: principles and mechanisms. Front Neuroendocrinol 1998, 19:323–362.

    Article  CAS  PubMed  Google Scholar 

  24. Cicero TJ, Nock B, O’Connor L, Meyer ER: Role of steroids in sex differences in morphine-induced analgesia: activational and organizational effects. J Pharmacol Exp Ther 2002, 300:695–701.

    Article  CAS  PubMed  Google Scholar 

  25. Jezzard P, Matthews PM, Smith SM: Functional MRI: an introduction to methods. New York: Oxford University Press; 2003.

    Google Scholar 

  26. Apkarian AV, Krauss BR, Fredrickson BE, Szeverenyi NM: Imaging the pain of low back pain: functional magnetic resonance imaging in combination with monitoring subjective pain perception allows the study of clinical pain states. Neurosci Lett 2001, 299:57–60.

    Article  CAS  PubMed  Google Scholar 

  27. Owen DG, Clarke CF, Ganapathy S, et al.: Using perfusion MRI to measure the dynamic changes in neural activation associated with tonic muscular pain. Pain 2010, 148:375–386.

    Article  PubMed  Google Scholar 

  28. Apkarian AV, Bushnell MC, Treede RD, Zubieta JK: Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain 2005, 9:463–484.

    Article  PubMed  Google Scholar 

  29. Fields HL, Basbaum AI: Central nervous system mechanisms of pain modulation. In Wall and Melzack’s Textbook of Pain, edn 5. Edited by MacMahon SB, Koltzenburg M. London: Churchill Livingstone; 2005:125–142.

    Google Scholar 

  30. Deroo BJ, Korach KS: Estrogen receptors and human disease. J Clin Invest 2006, 116:561–570.

    Article  CAS  PubMed  Google Scholar 

  31. Ghazni NF, Cahill CM, Stroman PW: Tactile sensory and pain networks in the human spinal cord and brain stem mapped by means of functional MR imaging. AJNR Am J Neuroradiol 2010, 31:661–667.

    Article  CAS  PubMed  Google Scholar 

  32. Choi JC, Park SK, Kim YH, et al.: Different brain activation patterns to pain and pain-related unpleasantness during the menstrual cycle. Anesthesiology 2006, 105:120–127.

    Article  PubMed  Google Scholar 

  33. de Leeuw R, Albuquerque RJ, Andersen AH, Carlson CR: Influence of estrogen on brain activation during stimulation with painful heat. J Oral Maxillofac Surg 2006, 64:158–166.

    Article  PubMed  Google Scholar 

  34. Smith YR, Stohler CS, Nichols TE, et al.: Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women. J Neurosci 2006, 26:5777–5785.

    Article  CAS  PubMed  Google Scholar 

  35. Craft RM, Ulibarri C, Leitl MD, Sumner JE: Dose- and time-dependent estradiol modulation of morphine antinociception in adult female rats. Eur J Pain 2008, 12:472–479.

    Article  CAS  PubMed  Google Scholar 

  36. Smith YR, Zubieta JK, del Carmen MG, et al.: Brain opioid receptor measurements by positron emission tomography in normal cycling women: relationship to luteinizing hormone pulsatility and gonadal steroid hormones. J Clin Endocrin Metab 1998, 83:4498–4505.

    Article  CAS  Google Scholar 

  37. Daniell HW: Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. J Pain 2008, 9:28–36.

    Article  CAS  PubMed  Google Scholar 

  38. Epperson CN, Haga K, Mason GF, et al.: Cortical gamma-aminobutyric acid levels across the menstrual cycle in healthy women and those with premenstrual dysphoric disorder: a proton magnetic resonance spectroscopy study. Arch Gen Psychiatry 2002, 59:851–858.

    Article  CAS  PubMed  Google Scholar 

  39. Hagelberg N, Martikainen IK, Mansikka H, et al.: Dopamine D2 receptor binding in the human brain is associated with the response to painful stimulation and pain modulatory capacity. Pain 2002, 99:273–279.

    Article  CAS  PubMed  Google Scholar 

  40. Scott DJ, Heitzeg MM, Koeppe RA, et al.: Variations in the human pain stress experience mediated by ventral and dorsal basal ganglia dopamine activity. J Neurosci 2006, 26:10789–10795.

    Article  CAS  PubMed  Google Scholar 

  41. Epperson CN, Haga K, Mason GF, et al.: Cortical gamma-aminobutyric acid levels across the menstrual cycle in healthy women and those with premenstrual dysphoric disorder: a proton magnetic resonance spectroscopy study. Arch Gen Psychiatry 2002, 59:851–858.

    Article  CAS  PubMed  Google Scholar 

  42. Amin Z, Epperson CN, Constable RT, Canli T: Effects of estrogen variation on neural correlates of emotional response inhibition. Neuroimage 2006, 32:457–464.

    Article  PubMed  Google Scholar 

  43. van Wingen G, Mattern C, Verkes RJ, et al.: Testosterone reduces amygdala-orbitofrontal cortex coupling. Psychoneuroendocrinology 2010, 35:105–113.

    Article  PubMed  Google Scholar 

  44. van Wingen G, van Broekhoven F, Verkes RJ, et al.: How progesterone impairs memory for biologically salient stimuli in healthy young women. J Neuroscience 2007, 27:11416–11423.

    Article  Google Scholar 

  45. van Wingen G, Mattern C, Verkes RJ, et al.: Testosterone biases automatic memory processes in women towards potential mates. Neuroimage 2008, 43:114–120.

    Article  PubMed  Google Scholar 

  46. Fernández G, Weis S, Stoffel-Wagner B, et al.: Menstrual cycle-dependent neural plasticity in the adult human brain is hormone, task, and region specific. J Neurosci 2003, 23:3790–3795.

    PubMed  Google Scholar 

  47. Smith YR, Love T, Persad CC, et al.: Impact of combined estradiol and norethindrone therapy on visuospatial working memory assessed by functional magnetic resonance imaging. J Clin Endocrinol Metab 2006, 91:4476–4481.

    Article  CAS  PubMed  Google Scholar 

  48. Persad CC, Zubieta JK, Love T, et al.: Enhanced neuroactivation during verbal memory processing in postmenopausal women receiving short-term hormone therapy. Fertil Steril 2009, 92:197–204.

    Article  CAS  PubMed  Google Scholar 

  49. Domes G, Lischke A, Berger C, et al.: Effects of intranasal oxytocin on emotional face processing in women. Psychoneuroendocrinology 2010, 35:83–93.

    Article  CAS  PubMed  Google Scholar 

  50. Merck: Menstrual Cycle. Available at http://www.merck.com/mmhe/sec22/ch241/ch241e.html.

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Disclosures

Dr. Katy Vincent has received an unrestricted educational grant from Pfizer. No other potential conflicts of interest relevant to this article were reported.

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Vincent, K., Tracey, I. Sex Hormones and Pain: The Evidence From Functional Imaging. Curr Pain Headache Rep 14, 396–403 (2010). https://doi.org/10.1007/s11916-010-0139-1

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