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Effects of Chronic Osteoarthritis Pain on Neuroendocrine Function in Men

Laboratory of Clinical Investigation (S.K., R.M., L.N., N.G., H.B., K.A.W., B.M., A.Ra., M.R.B.), Division of Intramural Research, National Center for Complementary and Alternative Medicine; Departments of Nursing (L.A.M.), Radiology (S.H.), and Laboratory Medicine (A.Re.), Warren Magnuson Clinical Center; Office of Clinical and Regulatory Affairs (L.L.J.), National Center for Complementary and Alternative Medicine; and Clinical Pain Research Section (M.B.M.), National Institute of Dental and Craniofacial Research, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Suzan Khoromi, M.D., M.H.S., National Institutes of Health, Building 10, 4-1741, Bethesda, Maryland 20892-1302. E-mail: khoromisu{at}mail.nih.gov.

Context: Chronic pain has been associated with elevated cortisol, reduced LH and testosterone (T), and/or augmented circulating or excreted catecholamines. Most endocrine studies have been conducted in patients in whom the potentially confounding effects of depression, inflammatory disease, or coexistent medication use have not been controlled.

Objective: The objective of the study was to test the hypothesis that chronic pain activates ACTH-cortisol and suppresses LH-T.

Design and Setting: This was a case control study conducted at a clinical research center.

Participants: Participants included 16 opioid-naive men with chronic osteoarthritis pain, aged 35–65 yr with body mass index 20–30 kg/m², and 12 healthy, opioid- and pain-free men of similar ages and body mass indexes.

Methods: We compared circulating concentrations of ACTH, cortisol, LH, and T derived from every 20-min blood sampling (2000–0800 h), and 24-h urinary excretion of cortisol, epinephrine, norepinephrine, and dopamine.

Results: There were no significant differences in mean or integrated concentrations of ACTH, cortisol, LH, or T, or in the corresponding approximate entropy scores in osteoarthritis patients, compared with control subjects. The 0800-h serum LH concentrations were elevated in patients vs. controls (6.42 ± 1.65 vs. 3.99 ± 1.54 IU/liter, mean ± SD, P = 0.02), whereas there were no significant group differences in total or free T, SHBG, cortisol binding globulin, dehydroepiandrosterone sulfate, or urinary cortisol and catecholamines.

Conclusions: These data suggest that neuroendocrine function is not significantly altered in otherwise healthy men with chronic musculoskeletal pain and that prior reports of such hormonal abnormalities may have resulted from the confounding effects of coexistent illness or medication use.