Department of Medicine (Endocrinology and Molecular Medicine), Surgery, and Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.
Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Advocate Aurora Research Institute, Milwaukee, WI, USA.
Stress. 2022 Jan;25(1):331-336. doi: 10.1080/10253890.2022.2142778.
Adolescent obesity augments and impedes the treatment of chronic pain. This is associated with increased systemic inflammation and is more prominent in females. In addition, pain and obesity each independently affect the hypothalamic-pituitary-adrenal (HPA) axis. However, the interaction of pain and obesity on the HPA axis and the potential for sexual dimorphism in this phenomenon is not established. We hypothesized that dysregulation of the HPA axis occurs in female human adolescents with chronic pain, obesity, or the combination of the two and is associated with gonadal steroids. We measured serum cortisol, estradiol, and testosterone in 13-17-year-old adolescent females ( = 79) from venous blood drawn during the daytime (0830-1730 h) and analyzed the data and partitioned by morning vs. afternoon sampling time. Subjects were categorized as healthy weight/no pain (controls; BMI = 56 percentile [37-71]), healthy weight with chronic pain, obese without pain (BMI = 97 percentile [95-99]), or the combination of obesity and chronic pain. Serum cortisol was lower with chronic pain and/or obesity compared to healthy controls and was lower with chronic pain and obesity compared to chronic pain alone (healthy weight). The lower serum cortisol in the pain alone group was more prominent in the morning compared to the afternoon. There was no relationship between serum estradiol and testosterone and study group. The decrease in the anti-inflammatory and other pain-ameliorating effects of cortisol may contribute to chronic pain and its resistance to treatment with concurrent obesity in female adolescents.
青少年肥胖会加重和阻碍慢性疼痛的治疗。这与全身性炎症增加有关，在女性中更为明显。此外，疼痛和肥胖都会独立影响下丘脑-垂体-肾上腺（HPA）轴。然而，疼痛和肥胖对 HPA 轴的相互作用以及这种现象中潜在的性别二态性尚未确定。我们假设慢性疼痛、肥胖或两者结合的女性青少年的 HPA 轴失调，并且与性腺类固醇有关。我们从静脉血中测量了 13-17 岁青春期女性（n=79）的血清皮质醇、雌二醇和睾酮，并在白天（0830-1730 小时）进行了分析，并根据早上和下午的采样时间对数据进行了分区。受试者分为健康体重/无疼痛（对照组；BMI = 56 百分位[37-71]）、健康体重伴有慢性疼痛、无疼痛肥胖（BMI = 97 百分位[95-99]）或肥胖伴有慢性疼痛。与健康对照组相比，慢性疼痛和/或肥胖患者的血清皮质醇水平较低，与慢性疼痛单独组相比，慢性疼痛和肥胖患者的血清皮质醇水平较低（健康体重）。仅疼痛组的血清皮质醇较低更为明显是在早上，而不是下午。血清雌二醇和睾酮与研究组之间没有关系。皮质醇的抗炎和其他缓解疼痛的作用降低可能导致慢性疼痛及其对肥胖的同时存在的治疗产生抗性，这种情况在女性青少年中更为明显。
