Naylor Jennifer C, Kilts Jason D, Strauss Jennifer L, Szabo Steven T, Dunn Charlotte E, Wagner H Ryan, Hamer Robert M, Shampine Lawrence J, Zanga Joseph R, Marx Christine E
J Rehabil Res Dev. 2016;53(4):499-510. doi: 10.1682/JRRD.2014.11.0294.
Female Veterans are the most rapidly growing segment of new users of the Veterans Health Administration (VHA), and a significant proportion of female Veterans receiving treatment from VHA primary care providers report persistent pain symptoms. Currently, available data characterizing the neurobiological underpinnings of pain disorders are limited. Preclinical data suggest that neurosteroids may be involved in the modulation of pain symptoms, potentially via actions at gamma-aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA) receptors. Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) are neurosteroids that modulate inhibitory GABA receptors and excitatory NMDA receptors, producing complex neuronal effects. Emerging evidence from male Iraq/Afghanistan-era Veterans suggests that reductions in neurosteroid levels are associated with increased pain symptoms and that neurosteroids may be promising biomarker candidates. The current exploratory study thus examined associations between self-reported pain symptoms in 403 female Iraq/Afghanistan-era Veterans and serum DHEAS and DHEA levels. Serum DHEAS levels were inversely correlated with low back pain in female Veterans (Spearman r = -0.103; p = 0.04). Nonparametric analyses indicate that female Veterans reporting moderate/extreme low back pain demonstrated significantly lower DHEAS levels than those reporting no/little low back pain (|Z| = 2.60; p = 0.009). These preliminary findings support a role for DHEAS in pain physiology of low back pain and the rationale for neurosteroid therapeutics in pain analgesia.
女性退伍军人是退伍军人健康管理局(VHA)新用户中增长最快的群体,很大一部分接受VHA初级保健提供者治疗的女性退伍军人报告有持续的疼痛症状。目前,有关疼痛障碍神经生物学基础的现有数据有限。临床前数据表明,神经甾体可能参与疼痛症状的调节,可能是通过作用于γ-氨基丁酸(GABA)和N-甲基-D-天冬氨酸(NMDA)受体。脱氢表雄酮(DHEA)和硫酸脱氢表雄酮(DHEAS)是调节抑制性GABA受体和兴奋性NMDA受体的神经甾体,产生复杂的神经元效应。来自伊拉克/阿富汗战争时期男性退伍军人的新证据表明,神经甾体水平的降低与疼痛症状的增加有关,神经甾体可能是很有前景的生物标志物候选物。因此,当前的探索性研究调查了403名伊拉克/阿富汗战争时期女性退伍军人自我报告的疼痛症状与血清DHEAS和DHEA水平之间的关联。女性退伍军人的血清DHEAS水平与下背部疼痛呈负相关(斯皮尔曼r=-0.103;p=0.04)。非参数分析表明,报告中度/重度下背部疼痛的女性退伍军人的DHEAS水平显著低于报告无/轻度下背部疼痛的女性退伍军人(|Z|=2.60;p=0.009)。这些初步发现支持了DHEAS在下背部疼痛生理中的作用以及神经甾体疗法用于疼痛镇痛的基本原理。
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