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Abstract
Understanding the role of the sex hormones in the pain mechanisms and various effects on nociceptors is imperative to managing potential underlying hormone disruptions in chronic pain syndromes. The myriad of overlapping symptoms between mid-life hormone imbalances and mid-life onset of fibromyalgia syndrome in women indicates a role for sex hormones in the etiology of fibromyalgia syndrome, which is, as of yet, unsupported by the literature. However, fibromyalgia treatment should be tailored to the individual needs of the patient, and adrenal, thyroid, and ovarian hormone support can lessen the painful burden of fibromyalgia through the modulation of various hormone-regulated pain-production pathways.
Understanding the role of the individual sex steroids in the production of pain perception and their various effects on nociceptors is imperative to managing potential underlying hormone disruptions in chronic pain syndromes.
Fibromyalgia syndrome (FMS) affects an estimated 5 million adults and the incidence, as with most noninflammatory musculoskeletal diseases, is higher in women than men (9:1).1,2 The incidence of FMS rises around menopause, and there is significant overlapping symptomology with hormone imbalances. FMS is also found to be highly prevalent among individuals exposed to a combination of physical injury and extreme stress.3
FMS is a musculoskeletal pain disorder of unknown etiology. The syndrome is characterized by chronic widespread, nonspecific, softtissue pain for which no alternative cause, such as tissue damage or inflammation, is noted.4 Individuals with FMS exhibit aberrant central pain processing, leading to hyperalgesia (heightened response to painful stimuli) and allodynia (painful responses to nonpainful stimuli) in addition to sleep disturbances and profound fatigue. This abnormal central pain processing is also implicated in irritable bowel syndrome (IBS), temporomandibular disorder, low back pain, and other chronic pain disorders. Widespread aching and stiffness in soft tissues, including muscle, tendon, ligament, and specifically tender points, as opposed to trigger points, are important for differential diagnosis of FMS from other chronic pain syndromes.5
Pain perception is a result of nociceptive input from peripheral afferent neurons sent via the dorsal horn of the spinal cord to the higher brain centers.6 Individuals with FMS exhibit a lower threshold for peripheral nerve ending activation leading to abnormal pain perception and hyperalgesia. The neurotransmitters serotonin, dopamine, norepinephrine (NE), and substance P are involved in the nociceptive processes....