Experimental characterization of the effects of acute stresslike doses of hydrocortisone in human neurogenic hyperalgesia models
Experimental characterization of the effects of acute stresslike doses of hydrocortisone in human neurogenic hyperalgesia models
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DOI：
10.1016/j.pain.2011.10.043
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发表时间：
2012-02-01
期刊：
影响因子：
7.4
通讯作者：
Treede, Rolf-Detlef
中科院分区：
文献类型：
--
作者：
Michaux, Gilles P. N.;Magerl, Walter;Treede, Rolf-Detlef
相对的下丘脑-垂体-肾上腺轴功能障碍已被描述为几种功能性疼痛综合征的共同特征，其终末激素皮质醇可能因此构成了防止慢性疼痛发展的保护因素。我们使用两种人类替代模型：前臂掌侧皮内注射辣椒素后的继发性痛敏和正常皮肤的知觉终止，研究了实验诱导的应激样皮质醇过多对神经源性痛敏诱导的潜在影响。在一项双盲、安慰剂对照、随机、交叉研究中，对10名健康受试者(中位年龄23岁)进行了一项心理物理研究，以考察口服40毫克氢化可的松的效果。对邻近辣椒素注射的继发性痛觉过敏区域和对侧对照侧施加点状、针刺和轻触刺激的疼痛评分进行了评估。此外，对未注射手臂的重复针刺刺激进行视觉模拟评分。氢化可的松显著减轻辣椒素诱导的晚期疼痛近50%，对针刺刺激的痛敏减少33%(P<；0.05)。基线机械性疼痛和动力性机械性异位痛感没有改变。机械性疼痛刺激的时间总和和电诱导的第二次疼痛总和(在10名其他受试者的独立队列中测试)也没有变化。氢化可的松对针刺痛过敏的选择性作用，而不是针刺痛，提示有抗过敏作用，而不是止痛作用。这一发现提示，下丘脑-垂体-肾上腺轴的反应性可能是抵抗功能性疼痛综合征的一个重要机制。(C)2011年国际疼痛研究协会。爱思唯尔出版公司版权所有。
Relative hypothalamic-pituitary-adrenal axis dysfunction has been described as a common feature of several dysfunctional pain syndromes, and its end hormone cortisol may thus constitute a protective factor against the development of chronic pain. We investigated the potential influence of experimentally induced stresslike hypercortisolism on the induction of neurogenic hyperalgesia using 2 human surrogate models: secondary hyperalgesia after intradermal capsaicin injection into the volar forearm, and perceptual windup in normal skin. In a double-blind, placebo-controlled, randomized, crossover study, a psychophysical study was performed in 10 healthy subjects (median age 23 years) examining the effects of 40 mg orally administered hydrocortisone. Numeric pain ratings were assessed for punctate pinprick and light touch stimuli applied to the zone of secondary hyperalgesia adjacent to the capsaicin injection and to the contralateral control side. In addition, visual analog ratings were assessed for repetitive pinprick stimulation of the noninjected arm. Hydrocortisone significantly attenuated the late phase of capsaicin-induced pain by nearly 50%, and hyperalgesia to pinprick stimuli by 33% (both P < .05). Baseline mechanical pain and dynamic mechanical allodynia remained unaltered. Temporal summation (windup) to mechanical pain stimuli and electrically induced windup of second pain (tested in an independent cohort of 10 other subjects) were also unchanged. The selective effects of hydrocortisone on pinprick hyperalgesia but not pinprick pain suggest an antihyperalgesic rather than analgesic effect. The findings suggest that hypothalamic-pituitary-adrenal axis reactivity might be an important mechanism in resilience to dysfunctional pain syndromes. (C) 2011 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.