SEX HORMONES, STRESS, AND PAIN IN FIBROMYALGIA

许多慢性疼痛障碍在女性中更为普遍。女性对实验引起的疼痛也表现出更高的敏感度。研究表明，性激素对人类中枢神经系统有多方面的影响，包括交感肾上腺和5-羟色胺能功能。这项建议的主要目的是测试一个概念模型的几个组成部分，该模型假设荷尔蒙和压力因素与纤维肌痛综合征(FMS)有关，FMS是一种主要见于女性的慢性肌肉骨骼疼痛疾病。我们将使用实验室和现场研究方法来评估性激素对FMS女性在月经周期中疼痛敏感性、应激反应和症状感知的影响，并与健康无痛女性(PFF)和男性(PFM)进行比较。具体地说，我们将测试性类固醇在FMS中的产生，应激源对交感-肾上腺功能的雌激素效应，对疼痛敏感性的雌激素效应，性激素在月经周期的围生期和FMS症状中的参与，以及睡眠和压力作为FMS中疼痛、疲劳和痛苦情绪的预测因子。共有300名受试者(FMS、PFF、PFM各100名)将接受家庭尿液测试、日常症状监测、血液和唾液采样，以及实验诱导的压力和疼痛测试。实验室检测将分3天重复：一次在黄体中期(高雌激素E+高孕酮P)，一次在围孕期(低E+低P)，一次在卵泡晚期(高E+低P)。男性受试者将被安排为女性受试者，而男性受试者将被安排在一个“枷锁循环”中。每个受试者将被随机分配到两种实验条件中的一种(在疼痛测试之前，“压力启动”任务与“非压力启动”任务)。在整个实验室过程中，将多次采集血压和唾液皮质醇样本。这一项目的发现有望促进人们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.