University of Siena, Siena, Italy.
Pain Physician. 2012 Jul;15(3 Suppl):ES111-8.
Gonadal hormones are critical factors in modulating the experience of pain, as suggested by the several sex differences observed: women have a greater risk of many clinical pain conditions, and postoperative and procedural pain may be more severe in them than in men. A growing body of literature demonstrates the role of estrogen in the female pain experience, whereas less attention has been given to testosterone and its functions. Nevertheless, testosterone has an appreciable role in both women and men: adequate serum levels are required in males and females for libido and sexuality; cellular growth; maintenance of muscle mass and bone; healing; blood-brain barrier; and for central nervous system maintenance. Pain therapy, and particularly opioid therapy, has been shown to affect testosterone plasma levels. Thus, the chronic administration of pain killers, such as opioids, requires the physician to be aware of both the consequences that can develop due to long-term testosterone impairment and the available means to restore and maintain physiological testosterone levels.
The objective is to highlight to pain physicians that the endocrine changes occurring during chronic pain therapy can participate in the body dysfunctions often present in chronic pain patients and that there are possible hormone replacement methods that can be carried out in men and women to improve their quality of life.
A comprehensive review of the literature.
A comprehensive review of the literature relating to opioid-induced hypogonadism, as well as other very common forms of hypogonadism, its endocrine effects, and possible therapeutic actions. The literature was collected from electronic and other sources. The reviewed literature included observational studies, case reports, systematic reviews, and guidelines.
Evaluation of the endocrine changes described in chronic pain therapy was the primary outcome measure. The secondary outcome measures were functional improvement and adverse effects of hormone replacement.
The results of the survey clearly show that sex hormone determination is very rare in pain centers. Given the complexity and widespread nature of pain therapy, there is a paucity of qualitative and quantitative literature regarding its endocrine consequences. The available evidence is weak for pain relief, but is consistent for many collateral effects, possibly deriving from pain therapy, such as fatigue, depression, and neurodegenerative diseases.
This is a narrative review without application of methodological quality assessment criteria. Even so, there is a paucity of literature concerning both controlled and observational literature for the endocrine effects of most analgesic drugs.
Testosterone replacement suffers from old prejudices about its utility and safety. With this review we illustrate the available therapeutic choices able to maintain T concentration into physiological ranges and reduce nociception with a final goal of improving patients' quality of life.
性腺激素是调节疼痛体验的关键因素，这一点可以从几个性别差异中看出：女性患许多临床疼痛疾病的风险更高，而且她们的术后和程序性疼痛可能比男性更严重。越来越多的文献表明雌激素在女性疼痛体验中的作用，而对睾丸激素及其功能的关注较少。然而，睾丸激素在女性和男性中都有相当大的作用：男性和女性都需要足够的血清水平来维持性欲和性功能；细胞生长；维持肌肉质量和骨骼；愈合；血脑屏障；以及中枢神经系统的维持。疼痛治疗，特别是阿片类药物治疗，已被证明会影响睾丸激素血浆水平。因此，长期使用止痛药，如阿片类药物，需要医生了解由于长期睾丸激素损害而可能出现的后果，以及恢复和维持生理睾丸激素水平的可用方法。
向疼痛医生强调，慢性疼痛治疗过程中发生的内分泌变化可能会参与到慢性疼痛患者中经常出现的身体功能障碍中，并且可以对男性和女性进行可能的激素替代治疗，以提高他们的生活质量。
对文献进行全面回顾。
对阿片类药物引起的性腺功能减退症以及其他常见形式的性腺功能减退症、其内分泌效应以及可能的治疗作用的文献进行全面回顾。文献资料来源于电子和其他来源。综述文献包括观察性研究、病例报告、系统评价和指南。
对慢性疼痛治疗中描述的内分泌变化的评估是主要的结果测量指标。次要结果测量指标是功能改善和激素替代的不良反应。
调查结果清楚地表明，在疼痛中心很少进行性激素测定。鉴于疼痛治疗的复杂性和广泛性，关于其内分泌后果的定性和定量文献很少。关于疼痛缓解的证据较弱，但对于许多可能源自疼痛治疗的副作用，如疲劳、抑郁和神经退行性疾病，证据是一致的。
这是一篇没有应用方法学质量评估标准的叙述性综述。即便如此，关于大多数镇痛药物的内分泌效应，无论是对照研究还是观察性研究，文献都很少。
睾丸激素替代疗法受到其效用和安全性的旧偏见的影响。通过这篇综述，我们说明了能够维持 T 浓度在生理范围内并降低伤害感受的可用治疗选择，最终目标是提高患者的生活质量。
