Effect of Estrogen Depletion on Pain Sensitivity in Aromatase Inhibitor-Treated Women With Early-Stage Breast Cancer
Effect of Estrogen Depletion on Pain Sensitivity in Aromatase Inhibitor-Treated Women With Early-Stage Breast Cancer
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DOI：
10.1016/j.jpain.2014.01.487
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发表时间：
2014-05-01
期刊：
影响因子：
4
通讯作者：
Harte, Steven E.
中科院分区：
文献类型：
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作者：
Henry, N. Lynn;Conlon, Anna;Harte, Steven E.
芳香酶抑制剂(Ais)用于治疗乳腺癌，可抑制绝经后妇女雌激素的产生。与AI相关的肌肉骨骼症状出现在大约一半的接受治疗的妇女中，并导致20%至30%的治疗中断。其病因可能部分归因于雌激素缺乏。在绝经前的女性中，较低的雌激素水平与疼痛增加以及下行疼痛抑制通路的损害有关，这可能是发展为慢性疼痛的一个危险因素。我们前瞻性地测试了AI诱导的雌激素剥夺是否改变了疼痛敏感性，从而增加了出现AI相关肌肉骨骼症状的风险。50名绝经后乳腺癌患者在人工智能开始前、3个月和6个月后接受了压痛测试和条件性疼痛调制(CPM)评估。基线时，40名接受评估的患者中有26名(65%)表现出CPM受损，这在以前接受过化疗的患者中更严重(P=0.006)。在雌激素剥夺后，压力痛阈值或CPM没有统计学上的显著变化。此外，AI治疗与疼痛敏感性的测量和患者报告的疼痛的变化都没有关联。AI相关的肌肉骨骼症状不太可能是由于治疗开始前痛阈值降低或CPM受损，或者雌激素耗竭对疼痛敏感性的影响。观点：本文介绍了我们关于雌激素剥夺对疼痛敏感性客观测量的影响的研究结果。在绝经后妇女中，药物诱导的雌激素耗竭不会导致可识别的压力痛阈值或CPM的变化。CPM受损可能与化疗有关。(C)美国疼痛协会2014年
Aromatase inhibitors (AIs), which are used to treat breast cancer, inhibit estrogen production in postmenopausal women. AI-associated musculoskeletal symptoms occur in approximately half of treated women and lead to treatment discontinuation in 20 to 30%. The etiology may be due in part to estrogen deprivation. In premenopausal women, lower estrogen levels have been associated with increased pain as well as with impairment of descending pain inhibitory pathways, which may be a risk factor for developing chronic pain. We prospectively tested whether AI-induced estrogen deprivation alters pain sensitivity, thereby increasing the risk of developing AI-associated musculoskeletal symptoms. Fifty postmenopausal breast cancer patients underwent pressure pain testing and conditioned pain modulation (CPM) assessment prior to AI initiation and after 3 and 6 months. At baseline, 26 of 40 (65%) assessed patients demonstrated impaired CPM, which was greater in those who had previously received chemotherapy (P=.006). No statistically significant change in pressure pain threshold or CPM was identified following estrogen deprivation. In addition, there was no association with either measure of pain sensitivity and change in patient-reported pain with AI therapy. AI-associated musculoskeletal symptoms are not likely due to decreased pain threshold or impaired CPM prior to treatment initiation, or to effects of estrogen depletion on pain sensitivity.Perspective: This article presents our findings of the effect of estrogen deprivation on objective measures of pain sensitivity. In postmenopausal women, medication-induced estrogen depletion did not result in an identifiable change in pressure pain threshold or CPM. Impaired CPM may be associated with chemotherapy. (C) 2014 by the American Pain Society