Kifle Zemene Demelash, Tian Jing, Aitken Dawn, Melton Phillip E, Cicuttini Flavia, Jones Graeme, Pan Feng
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; School of Global and Population Health, The University of Western Australia, Perth, Western Australia, Australia.
Br J Anaesth. 2025 Mar;134(3):793-803. doi: 10.1016/j.bja.2024.11.021. Epub 2024 Dec 19.
Sex-differences in pain perception have been documented; however, the role of sex hormones in chronic musculoskeletal pain (CMP) remains unclear. Therefore, this study investigated whether sex hormones and sex hormone-binding globulin (SHBG) are associated with CMP.
We utilised data from the UK Biobank (n=357 424; females: 51.6%; white: 95.2%). Serum concentrations of oestradiol (E2), testosterone (T), and SHBG were measured at baseline. Chronic pain (≥3 months) in the neck/shoulder, back, hip, knee, or 'all over the body' was assessed at baseline and three follow-ups. Mixed-effects multinomial/logistic regression models were used.
In multivariable analyses, greater concentrations of T and T/SHBG were associated with a lower number of CMP sites in both males (T: relative risk ratio=0.81 per standard deviation, 95% confidence interval [0.77-0.86] and T/SHBG: 0.85 [0.80-0.92]) and females (T: 0.85 [0.81-0.89] and T/SHBG: 0.93 [0.89-0.97] [all P-values for trend ≤0.001]). Greater T concentrations and T/SHBG were also associated with lower odds of CMP across all sites, while higher concentrations of SHBG were associated with lower odds of neck/shoulder CMP in both sexes. There was no association between concentrations of E2, SHBG, or E2/SHBG and number of CMP or site-specific CMP in either sex.
In both sexes, greater T concentrations and T/SHBG were associated with lower number of CMP sites and site-specific CMP, while greater concentrations of SHBG were linked to lower odds of neck/shoulder CMP. These findings suggest a potential involvement of sex steroids in the pathogenesis of CMP and underscore the need for further investigation into their potential in chronic pain management strategies.
疼痛感知方面的性别差异已有文献记载；然而，性激素在慢性肌肉骨骼疼痛（CMP）中的作用仍不清楚。因此，本研究调查了性激素和性激素结合球蛋白（SHBG）是否与CMP相关。
我们使用了英国生物银行的数据（n = 357424；女性：51.6%；白人：95.2%）。在基线时测量血清雌二醇（E2）、睾酮（T）和SHBG的浓度。在基线和三次随访时评估颈部/肩部、背部、臀部、膝盖或“全身”的慢性疼痛（≥3个月）。使用混合效应多项/逻辑回归模型。
在多变量分析中，较高的T浓度和T/SHBG与男性（T：每标准差相对风险比 = 0.81，95%置信区间[0.77 - 0.86]，T/SHBG：0.85[0.80 - 0.92]）和女性（T：0.85[0.81 - 0.89]，T/SHBG：0.93[0.89 - 0.97][所有趋势P值≤0.001]）中CMP部位数量较少相关。较高的T浓度和T/SHBG也与所有部位CMP的较低几率相关，而较高的SHBG浓度与男女颈部/肩部CMP的较低几率相关。E2、SHBG或E2/SHBG的浓度与任何一种性别的CMP数量或特定部位CMP之间均无关联。
在男女两性中，较高的T浓度和T/SHBG与较少的CMP部位数量和特定部位CMP相关，而较高的SHBG浓度与颈部/肩部CMP的较低几率相关。这些发现表明性类固醇可能参与了CMP的发病机制，并强调需要进一步研究它们在慢性疼痛管理策略中的潜力。
