Sex differences in hypothalamic–pituitary–adrenal axis function in patients with chronic pain syndrome

Turner‐Cobb, Julie M.; Osborn, Mike; Silva, Leonardo da; Keogh, Edmund; Jessop, David S.

doi:10.3109/10253890903524785

Cited by 23 publications

(17 citation statements)

References 59 publications

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“…The higher rates of depression and anxiety observed in females may be in part explained by sex hormones, as androgens seem to have anxiolytic properties whereas estrogens have been found to enhance HPA activity (Maeng & Milad, ; Turner‐Cobb, Osborn, Silva, Keogh, & Jessop, ). Furthermore, rates of depression in females correlate with hormonal changes, particularly with low levels of estrogen that occur throughout the life cycle (Albert et al, ).…”

Section: Sex Differences In Rates Of Depression and Anxietymentioning

confidence: 99%

The role of inflammation and the gut microbiome in depression and anxiety

Peirce

Alviña

2019

J of Neuroscience Research

331

201

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The study of the gut microbiome has increasingly revealed an important role in modulating brain function and mental health. In this review, we underscore specific pathways and mechanisms by which the gut microbiome can promote the development of mental disorders such as depression and anxiety. First, we review the involvement of the stress response and immune system activation in the development of depression and anxiety. Then, we examine germ‐free murine models used to uncover the role of the gut microbiome in developing and modulating pertinent activity in the brain and the immune system. We also document multiple pathways by which stress‐induced inflammation harms brain function and ultimately affects mental health, and review how probiotic and prebiotic treatments have shown to be beneficial. Lastly, we provide an overview of gut microbiome‐derived compounds (short‐chain fatty acids, tryptophan catabolites, microbial pattern recognition) and related mechanisms (vagal nerve activity and fecal microbiota transplants) involved in mediating the influence of the gut microbiome to mental health. Overall, a picture of the gut microbiome playing a facilitating role between stress response, inflammation, and depression, and anxiety is emerging. Future research is needed to firmly establish the microbiome's causal role, to further elucidate the mechanisms by which gut microbes influence brain function and mental health, and to possibly develop treatments that improve mental health through microbiotic targets.

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Section: Sex Differences In Rates Of Depression and Anxietymentioning

confidence: 99%

The role of inflammation and the gut microbiome in depression and anxiety

Peirce

Alviña

2019

J of Neuroscience Research

331

201

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“…Alternatively, two other studies found basal serum cortisol levels in fibromyalgia patients in the normal range [19,20]. However, the majority of previous studies (n < 100; one larger study: n = 429) found reduced activity and impaired feedback sensitivity of the HPA-axis in chronic pain conditions [13,19,21-26], mostly characterized by low basal levels of cortisol as well as a blunted cortisol response to a variety of stressors and dynamic tests. Although evidence is limited, some studies found increased salivary cortisol levels to be associated with higher pain severity scores among subjects with chronic widespread pain [27,28].…”

Section: Introductionmentioning

confidence: 99%

Reduced hypothalamic-pituitary-adrenal axis activity in chronic multi-site musculoskeletal pain: partly masked by depressive and anxiety disorders

Generaal

Vogelzangs

Macfarlane

et al. 2014

BMC Musculoskelet Disord

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BackgroundStudies on hypothalamic-pituitary-adrenal axis (HPA-axis) function amongst patients with chronic pain show equivocal results and well-controlled cohort studies are rare in this field. The goal of our study was to examine whether HPA-axis dysfunction is associated with the presence and the severity of chronic multi-site musculoskeletal pain.MethodsData are from the Netherlands Study of Depression and Anxiety including 1125 subjects with and without lifetime depressive and anxiety disorders. The Chronic Pain Grade questionnaire was used to determine the presence and severity of chronic multi-site musculoskeletal pain. Subjects were categorized into a chronic multi-site musculoskeletal pain group (n = 471) and a control group (n = 654). Salivary cortisol samples were collected to assess HPA-axis function (awakening level, 1-h awakening response, evening level, diurnal slope and post-dexamethasone level).ResultsIn comparison with the control group, subjects with chronic multi-site musculoskeletal pain showed significantly lower cortisol level at awakening, lower evening level and a blunted diurnal slope. Lower cortisol level at awakening and a blunted diurnal slope appeared to be restricted to those without depressive and/or anxiety disorders, who also showed a lower 1-h awakening response.ConclusionsOur results suggest hypocortisolemia in chronic multi-site musculoskeletal pain. However, if chronic pain is accompanied by a depressive or anxiety disorder, typically related to hypercortisolemia, the association between cortisol levels and chronic multi-site musculoskeletal pain appears to be partly masked. Future studies should take psychopathology into account when examining HPA-axis function in chronic pain.

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“…In a review of disparities between the sexes in cortisol responses to pain-related stress, differences were reported to be variable 14 . However, a more recent study of differences in diurnal cortisol patterns between the sexes in people with chronic pain, found that men had lower concentrations in the afternoon 27 . In a previous study of chronic pain in men with OA 13 no differences were found between those with OA and healthy controls and pain severity was not accounted for.…”

Section: Discussionmentioning

confidence: 95%

Exploring the relationship between disease-related pain and cortisol levels in women with osteoarthritis

Carlesso

Sturgeon

Zautra

2016

Osteoarthritis and Cartilage

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Objectives To determine if 1) Osteoarthritis (OA)-related pain is associated with the diurnal cortisol pattern and cortisol levels; 2) the diurnal pattern of cortisol varies with severity of OA pain and 3) the association between OA pain and cortisol is mediated by daily experience variables (DEV). Design In a community-based study of changes in regional and widespread pain among women with OA, participants (n=31) completed daily diaries and collected three saliva samples daily for 7 days. Severity of OA-related pain was assessed by the validated Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Multilevel regression analyses estimated associations between OA pain and diurnal cortisol levels and slopes, controlling for body mass index, medication use, time and day. Mediation analyses examined DEV as potential mediators of the association between OA pain and cortisol. Results The mean age was 57 years and average BMI 31kg/m2. Mean WOMAC pain subscale score was 8.8. Women with higher WOMAC pain scores had higher cortisol throughout the day. The estimated association of WOMAC with cortisol [ß 0.083(0.02, 0.15) p =0.009] represents a ~ 9% increase in cortisol for every unit increase in WOMAC pain score. Women with WOMAC pain scores ≥ 9 had higher cortisol levels than those with scores <9. Examination of DEV revealed no significant mediated associations between these relationships at the daily level. Conclusion In women with OA, disease-related pain is positively associated with cortisol production, particularly with greater pain severity. Future studies should explore biologic mediating variables between OA pain and cortisol.

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Sex differences in hypothalamic–pituitary–adrenal axis function in patients with chronic pain syndrome

Cited by 23 publications

References 59 publications

The role of inflammation and the gut microbiome in depression and anxiety

The role of inflammation and the gut microbiome in depression and anxiety

Reduced hypothalamic-pituitary-adrenal axis activity in chronic multi-site musculoskeletal pain: partly masked by depressive and anxiety disorders

Exploring the relationship between disease-related pain and cortisol levels in women with osteoarthritis

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