Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Muenster, Muenster, Germany.
Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim (CBTM), University Medicine Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany. Dr. Klein is now with Mundipharma Research GmbH & Co., KG, Limburg (Lahn), Germany.
Pain. 2019 Aug;160(8):1781-1793. doi: 10.1097/j.pain.0000000000001561.
The role of sex hormones on postsurgical pain perception is basically unclear. Here, we studied the role of endogenous gonadal hormones for pain and hyperalgesia in human volunteers after experimental incision. A 4-mm incision was made in the volar forearm of 15 female volunteers both in the follicular and the luteal phase (random block design). Somatosensory profiles were assessed at baseline and 1 to 72 hours after incision by quantitative sensory testing, compared between both cycle phases, and related to individual plasma levels of gonadal hormones. Sensory testing at baseline revealed significantly lower pain thresholds (25 vs 46 mN, P < 0.005) and increased pain ratings to pinprick (0.96 vs 0.47, P < 0.0001) in the luteal phase; similarly, 1 hour after incision, pain intensity to incision (38 vs 21/100, P < 0.005), pinprick hyperalgesia by rating (P < 0.05), and area of secondary hyperalgesia (P < 0.001) were enhanced in the luteal phase. Multiple regression analysis revealed that pinprick pain sensitivity at baseline was significantly predicted by progesterone (partial r = 0.67, P < 0.001), follicle-stimulating hormone (FSH) (partial r = 0.61, P < 0.005), and negatively by testosterone (partial r = -0.44, P < 0.05). Likewise, incision-induced pain and pinprick hyperalgesia (rating and area) were significantly predicted by progesterone (partial r = 0.70, r = 0.46, and r = 0.47, respectively; P < 0.05-0.0001) and in part by FSH; the contribution of estrogen, however, was fully occluded by progesterone for all measures. In conclusion, pinprick pain and incision-induced pain and mechanical hyperalgesia were greater in the luteal phase and predicted by progesterone, suggesting a major role for progesterone. Other hormones involved are testosterone (protective) and in part FSH.
性激素对术后疼痛感知的作用基本尚不清楚。在这里，我们研究了内源性性腺激素对人类志愿者实验性切口后疼痛和痛觉过敏的作用。在卵泡期和黄体期（随机块设计），在 15 名女性志愿者的掌侧前臂上均做一个 4mm 的切口。通过定量感觉测试，在基线和切口后 1 至 72 小时评估躯体感觉图谱，比较两个周期阶段，并与个体的性腺激素血浆水平相关。基线时的感觉测试显示，黄体期的疼痛阈值明显较低（25 对 46mN，P<0.005），针刺疼痛评分也较高（0.96 对 0.47，P<0.0001）；同样，切口后 1 小时，切口的疼痛强度（38 对 21/100，P<0.005）、针刺痛觉过敏评分（P<0.05）和继发性痛觉过敏面积（P<0.001）均增强。多元回归分析显示，基线时的针刺疼痛敏感性显著受孕酮（部分 r=0.67，P<0.001）、促卵泡激素（FSH）（部分 r=0.61，P<0.005）的影响，而受睾酮的影响则为负性（部分 r=-0.44，P<0.05）。同样，切口引起的疼痛和针刺痛觉过敏（评分和面积）也显著受孕酮的预测（部分 r=0.70，r=0.46，r=0.47，分别为 P<0.05-0.0001），部分受 FSH 的影响；然而，对于所有测量指标，雌激素的作用均被孕酮完全阻断。总之，黄体期针刺疼痛和切口引起的疼痛和机械性痛觉过敏更强，这与孕酮有关，提示孕酮起主要作用。其他涉及的激素是睾酮（保护）和部分 FSH。
