SEX HORMONES, STRESS, AND PAIN IN FIBROMYALGIA

许多慢性疼痛疾病在女性中更为普遍。 女性对实验性疼痛也表现出更大的敏感性。研究表明，性激素对人体中枢神经系统有多方面的影响，包括交感肾上腺和肾上腺素能功能。 本提案的主要目的是测试概念模型的几个组成部分，假设激素和压力因素与纤维肌痛综合征（FMS），一种慢性肌肉骨骼疼痛疾病，主要见于女性。 我们将使用实验室和现场研究方法来评估性激素在疼痛敏感性，应激反应和FMS女性月经周期的症状感知中的作用，并与健康无痛女性（PFF）和男性（PFM）进行比较。 具体来说，我们将测试性类固醇的生产在FMS，雌激素对交感神经肾上腺功能的影响，在应激源，雌激素对疼痛敏感性的影响，参与围月经期和FMS症状在月经周期，睡眠和压力的预测因子疼痛，疲劳，痛苦的情绪在FMS。 共300例受试者（FMS、PFF、PFM各100例）将接受家庭尿液检查、每日症状监测、血液和唾液采样以及实验诱导的应激和疼痛测试。 实验室检查将在3个不同的日子重复进行：一次在黄体中期（高雌激素E +高孕激素P），一次在围月经期（低E +低P），一次在卵泡晚期（高E +低P）。男性受试者将使用与女性受试者的“配对周期”进行计划。 每名受试者将被随机分配到两个实验条件之一（疼痛测试前的“压力引发”与“非压力引发”任务）。 在整个实验室检查期间，将对血压和唾液皮质醇进行多次采样。 该项目的研究结果有望促进更好地理解女性性激素在慢性疼痛障碍的有害感觉处理中的作用。

Many chronic pain disorders are more prevalent in women. Women also exhibit greater sensitivity to experimentally induced pain. Research has suggested that sex hormones exert multiple impacts upon human CNS, including the sympathoadrenal and serotonergic functions. The primary purpose of this proposal is to test several components of a conceptual model hypothesizing how the hormonal and stress factors are related to fibromyalgia syndrome (FMS), a chronic musculoskeletal pain disorder, predominantly seen in women. We will use both laboratory and field study approaches to evaluate the effects of sex hormones in pain sensitivity, stress reactivity, and symptom perception across a menstrual cycle in women with FMS, in comparisons to healthy pain-free females (PFF) and males (PFM). Specifically, we will test sex steroid production in FMS, estrogenic effects on the sympathoadrenal functions in response to stressors, estrogenic effects on pain sensitivity, involvement of sex hormones in perimenstrual and FMS symptoms across menstrual cycle, and sleep and stress as predictors of pain, fatigue, distressed mood in FMS. A total of 300 subjects (100 each in FMS, PFF, PFM) will undergo home urine tests, daily symptom monitoring, blood and saliva sampling, and experimentally induced stress and pain testing. The laboratory testing will be repeated on 3 separate days: once during the mid-luteal phase (high estrogen E + high progesterone P), once during the perimenstrual phase (low E + low P), and once during the late-follicular phase (high E + low P). Male subjects will be scheduled using a "yoked-cycle" to female subjects. Each subject will be randomly assigned to one of the two experimental conditions ("stress-priming" vs "non-stress- priming" tasks just prior to pain testing). Blood pressure and salivary cortisol will be sampled multiple times throughout the laboratory sessions. The findings from this project are expected to promote better understanding of the role of female sex hormones in noxious sensory processing in chronic pain disorders.