SEX HORMONES, STRESS, AND PAIN IN FIBROMYALGIA

许多慢性疼痛疾病在女性中更为普遍。女性对实验引起的疼痛也表现出更大的敏感性。研究表明性激素对人类中枢神经系统有多种影响，包括交感肾上腺和血清素功能。这个提议的主要目的是测试一个概念模型的几个组成部分，假设激素和压力因素如何与纤维肌痛综合征（FMS）相关，这是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实地研究的方法来评估性激素对FMS女性在月经周期中的疼痛敏感性、应激反应性和症状感知的影响，并与健康无痛女性（PFF）和男性（PFM）进行比较。具体来说，我们将测试FMS中性类固醇的产生，雌激素对交感肾上腺功能的影响，雌激素对疼痛敏感性的影响，月经周期中性激素在月经前后和FMS症状中的作用，以及睡眠和压力作为FMS中疼痛、疲劳、抑郁情绪的预测因子。共300名受试者（FMS、PFF、PFM各100名）将接受家庭尿液检测、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。实验室测试将在3天重复进行：一次在黄体中期（高雌激素E +高孕酮P），一次在月经期（低E +低P），一次在卵泡后期（高E +低P）。男性受试者将使用“轭式循环”来安排女性受试者。每个受试者将被随机分配到两个实验条件中的一个（“压力启动”和“非压力启动”任务，就在疼痛测试之前）。在整个实验过程中，血压和唾液皮质醇将被多次采样。这个项目的发现有望促进对女性性激素在慢性疼痛障碍中有害感觉处理中的作用的更好理解。

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.