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Kogler L, Müller VI, Moser E, Windischberger C, Gur RC, Habel U, Eickhoff SB, Derntl B. Testosterone and the Amygdala's Functional Connectivity in Women and Men. J Clin Med 2023; 12:6501. [PMID: 37892639 PMCID: PMC10607739 DOI: 10.3390/jcm12206501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
The amygdala contains androgen receptors and is involved in various affective and social functions. An interaction between testosterone and the amygdala's functioning is likely. We investigated the amygdala's resting-state functional connectivity (rsFC) network in association with testosterone in 94 healthy young adult women and men (final data available for analysis from 42 women and 39 men). Across the whole sample, testosterone was positively associated with the rsFC between the right amygdala and the right middle occipital gyrus, and it further predicted lower agreeableness scores. Significant sex differences appeared for testosterone and the functional connectivity between the right amygdala and the right superior frontal gyrus (SFG), showing higher testosterone levels with lower connectivity in women. Sex further predicted the openness and agreeableness scores. Our results show that testosterone modulates the rsFC between brain areas involved in affective processing and executive functions. The data indicate that the cognitive control of the amygdala via the frontal cortex is dependent on the testosterone levels in a sex-specific manner. Testosterone seems to express sex-specific patterns (1) in networks processing affect and cognition, and (2) in the frontal down-regulation of the amygdala. The sex-specific coupling between the amygdala and the frontal cortex in interaction with the hormone levels may drive sex-specific differences in a variety of behavioral phenomena that are further associated with psychiatric illnesses that show sex-specific prevalence rates.
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Affiliation(s)
- Lydia Kogler
- Department of Psychiatry and Psychotherapy, Tübingen Centre for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstrasse 14, 72076 Tübingen, Germany;
- German Center for Mental Health (DZPG) Partner Site, 72076 Tübingen, Germany
| | - Veronika I. Müller
- Institute of Neuroscience and Medicine: Brain and Behavior (INM-7), Research Centre Jülich, 52425 Jülich, Germany; (V.I.M.); (S.B.E.)
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Ewald Moser
- High-Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (E.M.); (C.W.)
| | - Christian Windischberger
- High-Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (E.M.); (C.W.)
| | - Ruben C. Gur
- Brain Behavior Laboratory and Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany;
- JARA BRAIN Institute I, Translational Brain Medicine, Forschungszentrum Jülich GmbH, 52425 Jülich, Germany
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine: Brain and Behavior (INM-7), Research Centre Jülich, 52425 Jülich, Germany; (V.I.M.); (S.B.E.)
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Tübingen Centre for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstrasse 14, 72076 Tübingen, Germany;
- German Center for Mental Health (DZPG) Partner Site, 72076 Tübingen, Germany
- LEAD Graduate School and Network, University of Tübingen, Walter-Simon-Straße 12, 72074 Tübingen, Germany
- International Max Planck Research School for the Mechanisms of Mental Function and Dysfunction (IMPRS-MMFD), Otfried-Müller-Str. 27, 72076 Tübingen, Germany
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Blythe JS, Thomaidou MA, Peerdeman KJ, van Laarhoven AI, van Schothorst MM, Veldhuijzen DS, Evers AW. Placebo effects on cutaneous pain and itch: a systematic review and meta-analysis of experimental results and methodology. Pain 2023; 164:1181-1199. [PMID: 36718994 PMCID: PMC10184563 DOI: 10.1097/j.pain.0000000000002820] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/14/2022] [Accepted: 10/20/2022] [Indexed: 02/01/2023]
Abstract
ABSTRACT Placebo effects, positive treatment outcomes that go beyond treatment processes, can alter sensations through learning mechanisms. Understanding how methodological factors contribute to the magnitude of placebo effects will help define the mechanisms by which these effects occur. We conducted a systematic review and meta-analysis of experimental placebo studies in cutaneous pain and itch in healthy samples, focused on how differences in methodology contribute to the resulting placebo effect magnitude. We conducted meta-analyses by learning mechanism and sensation, namely, for classical conditioning with verbal suggestion, verbal suggestion alone, and observational learning, separately for pain and itch. We conducted subgroup analyses and meta-regression on the type of sensory stimuli, placebo treatment, number of acquisition and evocation trials, differences in calibrated intensities for placebo and control stimuli during acquisition, age, and sex. We replicated findings showing that a combination of classical conditioning with verbal suggestion induced larger placebo effects on pain ( k = 68, g = 0 . 59) than verbal suggestion alone ( k = 39, g = 0.38) and found a smaller effect for itch with verbal suggestion alone ( k = 7, g = 0.14). Using sham electrodes as placebo treatments corresponded with larger placebo effects on pain than when topical gels were used. Other methodological and demographic factors did not significantly affect placebo magnitudes. Placebo effects on pain and itch reliably occur in experimental settings with varied methods, and conditioning with verbal suggestion produced the strongest effects. Although methods may shape the placebo effect to some extent, these effects appear robust overall, and their underlying learning mechanisms may be harnessed for applications outside the laboratory.
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Affiliation(s)
- Joseph S. Blythe
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Mia A. Thomaidou
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Kaya J. Peerdeman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Antoinette I.M. van Laarhoven
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Dieuwke S. Veldhuijzen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Andrea W.M. Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
- Medical Delta Healthy Society, Leiden University, Technical University Delft, and Erasmus University Rotterdam, Rotterdam, the Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
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Zunhammer M, Spisák T, Wager TD, Bingel U. Meta-analysis of neural systems underlying placebo analgesia from individual participant fMRI data. Nat Commun 2021; 12:1391. [PMID: 33654105 PMCID: PMC7925520 DOI: 10.1038/s41467-021-21179-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
The brain systems underlying placebo analgesia are insufficiently understood. Here we performed a systematic, participant-level meta-analysis of experimental functional neuroimaging studies of evoked pain under stimulus-intensity-matched placebo and control conditions, encompassing 603 healthy participants from 20 (out of 28 eligible) studies. We find that placebo vs. control treatments induce small, widespread reductions in pain-related activity, particularly in regions belonging to ventral attention (including mid-insula) and somatomotor networks (including posterior insula). Behavioral placebo analgesia correlates with reduced pain-related activity in these networks and the thalamus, habenula, mid-cingulate, and supplementary motor area. Placebo-associated activity increases occur mainly in frontoparietal regions, with high between-study heterogeneity. We conclude that placebo treatments affect pain-related activity in multiple brain areas, which may reflect changes in nociception and/or other affective and decision-making processes surrounding pain. Between-study heterogeneity suggests that placebo analgesia is a multi-faceted phenomenon involving multiple cerebral mechanisms that differ across studies.
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Affiliation(s)
- Matthias Zunhammer
- Center for Translational Neuro- and Behavioral Sciences, Dept. of Neurology, University Hospital Essen, Essen, Germany
| | - Tamás Spisák
- Center for Translational Neuro- and Behavioral Sciences, Dept. of Neurology, University Hospital Essen, Essen, Germany
| | - Tor D Wager
- Cognitive and Affective Neuroscience Laboratory, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
| | - Ulrike Bingel
- Center for Translational Neuro- and Behavioral Sciences, Dept. of Neurology, University Hospital Essen, Essen, Germany.
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Distinct neural networks subserve placebo analgesia and nocebo hyperalgesia. Neuroimage 2021; 231:117833. [PMID: 33549749 DOI: 10.1016/j.neuroimage.2021.117833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/20/2021] [Accepted: 01/30/2021] [Indexed: 12/19/2022] Open
Abstract
Neural networks involved in placebo analgesia and nocebo hyperalgesia processes have been widely investigated with neuroimaging methods. However, few studies have directly compared these two processes and it remains unclear whether common or distinct neural circuits are involved. To address this issue, we implemented a coordinate-based meta-analysis and compared neural representations of placebo analgesia (30 studies; 205 foci; 677 subjects) and nocebo hyperalgesia (22 studies; 301 foci; 401 subjects). Contrast analyses confirmed placebo-specific concordance in the right ventral striatum, and nocebo-specific concordance in the dorsal anterior cingulate cortex (dACC), left posterior insula and left parietal operculum during combined pain anticipation and administration stages. Importantly, no overlapping regions were found for these two processes in conjunction analyses, even when the threshold was low. Meta-analytic connectivity modeling (MACM) and resting-state functional connectivity (RSFC) analyses on key regions further confirmed the distinct brain networks underlying placebo analgesia and nocebo hyperalgesia. Together, these findings indicate that the placebo analgesia and nocebo hyperalgesia processes involve distinct neural circuits, which supports the view that the two phenomena may operate via different neuropsychological processes.
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Kato Y, Shigehara K, Kawaguchi S, Izumi K, Kadono Y, Mizokami A. Efficacy of testosterone replacement therapy on pain in hypogonadal men with chronic pain syndrome: A subanalysis of a prospective randomised controlled study in Japan (EARTH study). Andrologia 2020; 52:e13768. [DOI: 10.1111/and.13768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/10/2020] [Accepted: 06/28/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Yuki Kato
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
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Zunhammer M, Bingel U, Wager TD. Placebo Effects on the Neurologic Pain Signature: A Meta-analysis of Individual Participant Functional Magnetic Resonance Imaging Data. JAMA Neurol 2019; 75:1321-1330. [PMID: 30073258 DOI: 10.1001/jamaneurol.2018.2017] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Placebo effects reduce pain and contribute to clinical analgesia, but after decades of research, it remains unclear whether placebo treatments mainly affect nociceptive processes or other processes associated with pain evaluation. Objective We conducted a systematic, participant-level meta-analysis to test the effect of placebo treatments on pain-associated functional neuroimaging responses in the neurologic pain signature (NPS), a multivariate brain pattern tracking nociceptive pain. Data Sources Medline (PubMed) was searched from inception to May 2015; the search was augmented with results from previous meta-analyses and expert recommendations. Study Selection Eligible studies were original investigations that were published in English in peer-reviewed journals and that involved functional neuroimaging of the human brain with evoked pain delivered under stimulus intensity-matched placebo and control conditions. The authors of all eligible studies were contacted and asked to provide single-participant data. Data Extraction and Synthesis Data were collected between December 2015 and November 2017 following the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data guidelines. Results were summarized across participants and studies in a random-effects model. Main Outcomes and Measures The main, a priori outcome was NPS response; pain reports were assessed as a secondary outcome. Results We obtained data from 20 of 28 identified eligible studies, resulting in a total sample size of 603 healthy individuals. The NPS responses to painful stimulation compared with baseline conditions were positive in 575 participants (95.4%), with a very large effect size (g = 2.30 [95% CI, 1.92 to 2.69]), confirming its sensitivity to nociceptive pain in this sample. Placebo treatments showed significant behavioral outcomes on pain ratings in 17 of 20 studies (85%) and in the combined sample (g = -0.66 [95% CI, -0.80 to -0.53]). However, placebo effects on the NPS response were significant in only 3 of 20 studies (15%) and were very small in the combined sample (g = -0.08 [95% CI, -0.15 to -0.01]). Similarly, analyses restricted to studies with low risk of bias (g = -0.07 [95% CI, -0.15 to 0.00]) indicated very small effects, and analyses of just placebo responders (g = -0.22 [95% CI, -0.34 to -0.11]) indicated small effects, as well. Conclusions and Relevance Placebo treatments have moderate analgesic effects on pain reports. The very small effects on NPS, a validated measure that tracks levels of nociceptive pain, indicate that placebo treatments affect pain via brain mechanisms largely independent of effects on bottom-up nociceptive processing.
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Affiliation(s)
| | - Ulrike Bingel
- Klinik für Neurologie, Universitätsklinikum Essen, Essen, Germany
| | - Tor D Wager
- Department of Psychology and Neuroscience, University of Colorado, Boulder
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Kang HY, Shin D, Kang EK. Correlation of Pressure Pain Threshold with Segmental Water Content among Female Farmers. TOHOKU J EXP MED 2019; 248:217-223. [PMID: 31366820 DOI: 10.1620/tjem.248.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Body composition (BC) is related to the pathogenesis of musculoskeletal disease, especially research focused on the role of fat and muscle mass. This study aimed to identify the associations between the pressure pain threshold (PPT) and pain-related factors including BC. A total of 64 healthy farmers (21 males and 43 females) were recruited, and baseline data were analyzed cross-sectionally. Demographic characteristics (sex, age, marital status, education duration, current status of smoking and alcohol drinking, height, body weight, and underlying diseases) and a psychologic characteristic (a Korean version of the Beck Depression Inventory [BDI]) were assessed. Additionally, body composition analysis using bioelectrical impedance analysis (BIA) was performed. PPT was measured by applying an increasing amount of blunt pressure using a 1 cm2 hard rubber end at the thenar region of the right hand with a constant increase in pressure of 50 kPa/s. The PPT was measured on a single day, and the average value was used for analysis. The male group (67.00 ± 9.12 years) was older than the female group (62.21 ± 6.77 years; p = 0.021). In the body composition analysis, only segmental water of the right arm was positively related to PPT (β = 0.331, p = 0.030) in the multivariate linear regression analysis. In conclusion, hydration status was related to PPT with clinical implication that sufficient hydration could reduce the pain susceptibility. Thus, when assessing the painful condition, checking the hydration status could be helpful before the intensive treatment.
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Affiliation(s)
- Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University
| | - Dabi Shin
- Department of Rehabilitation Medicine, Kangwon National University Hospital, and School of Medicine, Kangwon National University
| | - Eun Kyoung Kang
- Department of Rehabilitation Medicine, Kangwon National University Hospital, and School of Medicine, Kangwon National University
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Choi JC, Park YH, Park SK, Lee JS, Kim J, Choi JI, Yoon KB, Lee S, Lim DE, Choi JY, Kim MH, Park G, Choi SS, Lee JM. Testosterone effects on pain and brain activation patterns. Acta Anaesthesiol Scand 2017; 61:668-675. [PMID: 28573655 DOI: 10.1111/aas.12908] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/27/2017] [Accepted: 04/28/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study investigated whether pain and pain-related unpleasantness ratings were altered by blood testosterone levels. We also investigated whether activation of brain regions that represent pain intensity [primary somatosensory cortex (S1)] and pain-related unpleasantness [perigenual ACC (pACC) and orbitofrontal cortex (OFC)] were affected by blood testosterone levels. METHODS Twenty-six healthy men were recruited. Blood testosterone levels were measured before fMRI scanning. The participants were classified into two groups (high vs. low testosterone) according to their blood testosterone level (each group n = 13). The middle finger was immersed in a 50°C water bath (50°C, 30 s, five times) to induce identical noxious stimulation in all participants. RESULTS The low testosterone group showed statistically significantly higher pain (P = 0.047), unpleasantness (P = 0.047), anxiety (P = 0.015), and fear ratings (P = 0.01) than the high testosterone group. Fear rating increased as pain rating rose and as testosterone level decreased (P < 0.001). When participants received noxious stimulation, the pACC and OFC were more highly activated in the low testosterone group compared to the high testosterone group. Activation of S1, a region related to pain intensity, did not differ between both groups. CONCLUSION Compared to the high testosterone group, the low testosterone group had significant activation in the pACC and OFC, regions that represent pain-related unpleasantness, but not in S1 that represents pain intensity, leading to higher pain ratings. These findings emphasize the importance of considering the effects of testosterone levels when treating patients.
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Affiliation(s)
- J. C. Choi
- Department of Anesthesiology and Pain Medicine; Intensive Care Unit; Brain Research Group; Yonsei University Wonju College of Medicine; Wonju Gangwon-do South Korea
| | - Y.-H. Park
- Department of Biomedical Engineering; Hanyang University; Seoul South Korea
| | - S. K. Park
- Yonsei Danaa Pain Clinic; Seoul South Korea
| | - J. S. Lee
- Department of Biomedical Engineering; Hanyang University; Seoul South Korea
| | - J. Kim
- Department of Psychology; Kangwon National University; Chuncheon Gangwon-do South Korea
| | - J. I. Choi
- Dr. Choi's Rehab & Pain Clinic; Ansan Gyeonggi-do South Korea
| | - K. B. Yoon
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Republic of Korea
| | - S. Lee
- Department of Anesthesiology and Pain Medicine; Haeundae Paik Hospital; Inje University; Busan South Korea
| | - D. E. Lim
- Department of Orthopaedic surgery; Modu Hospital; Incheon South Korea
| | - J. Y. Choi
- Department of Neurosurgery; Gangbuk 21st Century Hospital; Seoul South Korea
| | - M. H. Kim
- Department of Anesthesiology and Pain Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon-do South Korea
| | - G. Park
- Department of Anesthesiology and Pain Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon-do South Korea
| | - S. S. Choi
- Department of Anaesthesiology and Pain Medicine; Guro Hospital; Korea University; Seoul South Korea
| | - J.-M. Lee
- Department of Biomedical Engineering; Hanyang University; Seoul South Korea
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Kiałka M, Milewicz T, Sztefko K, Rogatko I, Majewska R. Metformin increases pressure pain threshold in lean women with polycystic ovary syndrome. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2483-90. [PMID: 27536069 PMCID: PMC4977100 DOI: 10.2147/dddt.s109086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Despite the strong preclinical rationale, there are only very few data considering the utility of metformin as a potential pain therapeutic in humans. The aim of this study was to determine the association between metformin therapy and pressure pain threshold (PPT) in lean women with polycystic ovary syndrome (PCOS). We hypothesized that metformin therapy in lean PCOS women increases PPT. Materials and methods Twenty-seven lean PCOS women with free androgen index phenotype >5 and 18 lean healthy controls were enrolled in the study. Fifteen of the PCOS women were randomly assigned to be treated with metformin 1,500 mg daily for 6 months. PPT and plasma β-endorphin levels were measured in all women at the beginning of the study and after 6 months of observation. Results We observed an increase in PPT values measured on deltoid and trapezius muscle in the PCOS with metformin group after 6 months of metformin administration (4.81±0.88 kg/cm2, P<0.001 on deltoid muscle, and 5.71±1.16 kg/cm2 on trapezius muscle). We did not observe any significant changes in PPT values in the PCOS without treatment group and in controls. We did not observe any significant changes in serum β-endorphin levels in any studied groups during the 6-month observation. Conclusion We conclude that metformin therapy increases PPT in lean PCOS women, without affecting plasma β-endorphin concentration. Our results may suggest the potential role of metformin in pain therapy. We propose that larger, randomized studies on metformin impact on pain perception should be performed.
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Affiliation(s)
- Marta Kiałka
- Department of Gynecological Endocrinology, Jagiellonian University, Medical College, Kraków, Poland
| | - Tomasz Milewicz
- Department of Gynecological Endocrinology, Jagiellonian University, Medical College, Kraków, Poland
| | - Krystyna Sztefko
- Department of Clinical Biochemistry, Jagiellonian University, Medical College, Kraków, Poland
| | - Iwona Rogatko
- Department of Clinical Biochemistry, Jagiellonian University, Medical College, Kraków, Poland
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
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Heany SJ, van Honk J, Stein DJ, Brooks SJ. A quantitative and qualitative review of the effects of testosterone on the function and structure of the human social-emotional brain. Metab Brain Dis 2016; 31:157-67. [PMID: 26073231 PMCID: PMC4718938 DOI: 10.1007/s11011-015-9692-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/26/2015] [Indexed: 02/08/2023]
Abstract
Social and affective research in humans is increasingly using functional and structural neuroimaging techniques to aid the understanding of how hormones, such as testosterone, modulate a wide range of psychological processes. We conducted a meta-analysis of functional magnetic resonance imaging (fMRI) studies of testosterone administration, and of fMRI studies that measured endogenous levels of the hormone, in relation to social and affective stimuli. Furthermore, we conducted a review of structural MRI i.e. voxel based morphometry (VBM) studies which considered brain volume in relation to testosterone levels in adults and in children. In the included testosterone administration fMRI studies, which consisted of female samples only, bilateral amygdala/parahippocampal regions as well as the right caudate were significantly activated by social-affective stimuli in the testosterone condition. In the studies considering endogenous levels of testosterone, stimuli-invoked activations relating to testosterone levels were noted in the bilateral amygdala/parahippocampal regions and the brainstem. When the endogenous testosterone studies were split by sex, the significant activation of the brain stem was seen in the female samples only. Significant stimuli-invoked deactivations relating to endogenous testosterone levels were also seen in the right and left amygdala/parahippocampal regions studies. The findings of the VBM studies were less consistent. In adults larger volumes in the limbic and temporal regions were associated with higher endogenous testosterone. In children, boys showed a positive correlation between testosterone and brain volume in many regions, including the amygdala, as well as global grey matter volume, while girls showed a neutral or negative association between testosterone levels and many brain volumes. In conclusion, amygdalar and parahippocampal regions appear to be key target regions for the acute actions of testosterone in response to social and affective stimuli, while neurodevelopmentally the volumes of a broader network of brain structures are associated with testosterone levels in a sexually dimorphic manner.
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Affiliation(s)
- Sarah J Heany
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, J2, Anzio road, Observatory, Cape Town, South Africa.
| | - Jack van Honk
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, J2, Anzio road, Observatory, Cape Town, South Africa
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, J2, Anzio road, Observatory, Cape Town, South Africa
| | - Samantha J Brooks
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, J2, Anzio road, Observatory, Cape Town, South Africa
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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11
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Bear T, Philipp M, Hill S, Mündel T. A preliminary study on how hypohydration affects pain perception. Psychophysiology 2016; 53:605-10. [DOI: 10.1111/psyp.12610] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/17/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Tracey Bear
- School of Sport and Exercise; Massey University; Palmerston North New Zealand
- School of Psychology; Massey University; Palmerston North New Zealand
- School of Food and Nutrition; Massey University; Palmerston North New Zealand
| | - Michael Philipp
- School of Psychology; Massey University; Palmerston North New Zealand
| | - Stephen Hill
- School of Psychology; Massey University; Palmerston North New Zealand
| | - Toby Mündel
- School of Sport and Exercise; Massey University; Palmerston North New Zealand
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12
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Choi JC, Kim J, Kang E, Choi JH, Park WY, Choi YS, Cha J, Han C, Park SK, Kim MH, Lee GH, Do HJ, Jung SW, Lee JM. Step-down vs. step-up noxious stimulation: differential effects on pain perception and patterns of brain activation. Acta Anaesthesiol Scand 2016; 60:117-27. [PMID: 26355384 DOI: 10.1111/aas.12607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 07/13/2015] [Accepted: 07/29/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND We hypothesize that pain and brain responses are affected by changes in the presentation sequence of noxious stimuli that are, overall, identical in intensity and duration. METHODS During functional magnetic resonance imaging (fMRI) scanning, 21 participants experienced three patterns of noxious stimulation: Up-type (step-up noxious stimulation, 15 s), Down-type (step-down noxious stimulation, 15 s), and Down-up-type (decreasing and increasing pattern of noxious stimulation, 15 s). The total intensity and duration of the three noxious stimulation patterns were identical, but the stimulation sequences were different. RESULTS Pain and unpleasantness ratings in the Down- and Down-up-type noxious stimulations were lower than in the Up-type noxious stimulation. The left prefrontal cortex [(PFC, BA (Brodmann area) 10, (-45, 50, 1)] was more highly activated in the Down- and Down-up-type noxious stimulations than in the Up-type noxious stimulation. The S1, S2, insula, bilateral PFC (BA 46), and midcingulate cortex were more highly activated in the Up-type noxious stimulation than in the Down-type noxious stimulation. PFC BA 10 was located at an inferior level compared to the bilateral PFC BA 46 (Z axis = 1 for BA 10, compared to 22 and 25 for the right and left BA 46, respectively). When cortisol level was increased, the left hippocampal cortex, along with the left parahippocampal cortex, was greatly activated for the Up-type noxious stimulation. CONCLUSION When pain cannot be avoided in clinical practice, noxious stimuli should be applied to patients in a step-down pattern that delivers the most intense pain first and the least intense pain last.
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Affiliation(s)
- J. C. Choi
- Department of Anesthesiology and Pain Medicine; Intensive Care Unit; Brain Research Group; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - J. Kim
- Department of Psychology; Kangwon National University; Chuncheon South Korea
| | - E. Kang
- Department of Psychology; Kangwon National University; Chuncheon South Korea
| | - J.-H. Choi
- Julie English Institute; Wonju South Korea
| | - W. Y. Park
- Department of Anesthesiology and Pain Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - Y.-S. Choi
- Department of Electronic Engineering; Gangneung-Wonju National University; Gangneung South Korea
| | - J. Cha
- Department of Biomedical Engineering; Hanyang University; Seoul South Korea
| | - C. Han
- University of Manchester Medical School; Manchester UK
| | - S. K. Park
- Yonsei Saebom Medical Clinic; Seongdong-gu Seoul South Korea
| | - M. H. Kim
- Medical Library; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - G. H. Lee
- Instructional Department; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - H.-J. Do
- Department of Anesthesiology and Pain Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - S. W. Jung
- Department of Anesthesiology and Pain Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - J.-M. Lee
- Department of Biomedical Engineering; Hanyang University; Seoul South Korea
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Choi JC, Kim J, Kang E, Lee JM, Cha J, Kim YJ, Lee HG, Choi JH, Yi DJ. Brain mechanisms of pain relief by transcutaneous electrical nerve stimulation: A functional magnetic resonance imaging study. Eur J Pain 2015; 20:92-105. [PMID: 25847717 DOI: 10.1002/ejp.696] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although the exact mechanism of TENS pain relief is unknown, it is believed that TENS impulses interrupt nociceptive signals at the dorsal horn of the spinal cord. AIMS To evaluate the hypotheses that during pain caused by noxious stimuli, brain responses, temporal summation and brain functional connectivity are modulated by TENS, and that mechanisms of pain relief by TENS differ between men and women. METHODS During fMRI scanning, the same noxious stimuli were delivered to each participant in pain-only and pain+TENS conditions. In the pain-only condition, noxious stimuli were presented without TENS. In the pain+TENS condition, participants received noxious stimuli and TENS concurrently. Participants were initially presented with TENS at an intensity that was just below that causing discomfort. TENS intensity was presented in a step-wise fashion to prevent temporal summation from repetitive noxious stimuli. RESULTS Pain and unpleasantness ratings were significantly higher in the pain-only than the pain+TENS condition. With non-painful TENS, primary and secondary somatosensory and parietal cortices were activated, and temporal summation from repetitive noxious stimuli was prevented. Periaqueductal gray (PAG) and lateral prefrontal cortex functional connectivity was increased by TENS, and modulated by testosterone and cortisol. Women reported greater pain during TENS than men, and showed greater activation in the temporoparietal junction cortex and increased PAG functional connectivity with the orbitofrontal cortex. CONCLUSION TENS led to pain reduction, probably due to activation of the descending pain-inhibitory pathway, indicating that this TENS method may be applied in clinical practice.
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Affiliation(s)
- J C Choi
- Department of Anesthesiology and Pain Medicine, Intensive Care Unit, Brain Research Group, Yonsei University Wonju College of Medicine, South Korea
| | - J Kim
- Department of Psychology, Kangwon National University, Chuncheon, South Korea
| | - E Kang
- Department of Psychology, Kangwon National University, Chuncheon, South Korea
| | - J-M Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - J Cha
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Y J Kim
- Department of Radiology, Yonsei University Wonju College of Medicine, South Korea
| | - H G Lee
- Department of Radiology, Yonsei University Wonju College of Medicine, South Korea
| | - J-H Choi
- Julie English Institute, Wonju, South Korea
| | - D-J Yi
- Department of Psychology, Yonsei University, Seoul, Korea
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Choi JC, Lee JH, Choi E, Chung MI, Seo SM, Lim HK. Effects of seasonal differences in testosterone and cortisol levels on pain responses under resting and anxiety conditions. Yonsei Med J 2014; 55:216-23. [PMID: 24339310 PMCID: PMC3874911 DOI: 10.3349/ymj.2014.55.1.216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study investigated whether hormones and pain perception are associated with exam anxiety, and also whether exam anxiety is affected by seasonal differences in testosterone and cortisol levels. MATERIALS AND METHODS Forty-six healthy males were recruited from a medical college. Anxiety was induced by having participants perform the Objective Structured Clinical Examination. Pressure was applied to the participants to induce pain. Pain thresholds, pain ratings, anxiety ratings, blood pressure, heart rate, salivary testosterone and cortisol levels were measured under resting and anxiety conditions in the spring and summer. Data were collected from 46 participants during the spring (n=25) and summer (n=21). RESULTS Pain thresholds and testosterone levels were significantly lower under anxiety than at rest for all participants (n=46), while cortisol levels, pain ratings, and anxiety ratings were significantly higher under anxiety than at rest. In the spring (n=25), testosterone levels were significantly higher at rest than under anxiety, while there was no difference in cortisol levels between resting and anxiety conditions. In the summer (n=21), cortisol levels were significantly higher under anxiety than at rest, while there was no difference in testosterone levels between resting and anxiety conditions. There were no significant seasonal differences in pain and anxiety ratings and pain threshold. CONCLUSION These results indicate that seasonal differences in testosterone and cortisol levels under anxiety and at rest may affect pain responses. These results also suggest that acute clinical pain may be relieved by managing anxiety that is related to a decrease of testosterone in spring and a large increase of cortisol in summer.
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Affiliation(s)
- Jae Chan Choi
- Department of Anesthesiology and Pain Medicine, Brain Research Group, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea.
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Choi JC, Min S, Kim YK, Choi JH, Seo SM, Chang SJ. Changes in pain perception and hormones pre- and post-kumdo competition. Horm Behav 2013; 64:618-23. [PMID: 24005187 DOI: 10.1016/j.yhbeh.2013.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/20/2013] [Accepted: 08/23/2013] [Indexed: 11/24/2022]
Abstract
The psychological stress of competition is a powerful stimulus affecting numerous hormones, which in turn change how pain is perceived. This study investigated whether a kumdo (kendo) team competition may be related to changes in hormones and pain. Seventeen healthy male kumdo practitioners participated in this experiment. Pain experiments were conducted by applying noxious stimuli with a thermal stimulator 10 min before a kumdo competition and 30 min post-competition. Serum testosterone, cortisol, beta-endorphin levels, pain thresholds, pain ratings at 48 °C and during blood sampling (sampling pain), anxiety, blood pressure, and heart rate were measured pre- and post-competition. Anxiety, pain threshold, testosterone/cortisol ratio, and blood pressure were significantly higher pre-competition compared to post-competition, while cortisol and pain ratings were significantly lower pre-competition than post-competition. There were significant correlations between the number of previous competitions and testosterone levels both pre-competition and post-competition. In pre-competition measurements, sampling pain increased with an increase in systolic blood pressure, heart rate, and beta-endorphins, and a decrease in age. In post-competition measurements, sampling pain increased with an increase in diastolic blood pressure and a decrease in testosterone levels. These results indicate that severe psychological pre-competition stress was associated with reduced pain ratings, perhaps in order to improve athletic performance. This also suggests that competitors may be at risk of potential injury due to changes in pain perception, and careful consideration should be taken to avoid potential injury before and during competition.
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Affiliation(s)
- Jae Chan Choi
- Department of Anesthesiology and Pain Medicine, Brain Research Group, Yonsei University Wonju College of Medicine, Wonju, South Korea.
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Choi JC, Chung MI, Lee YD. Modulation of pain sensation by stress-related testosterone and cortisol. Anaesthesia 2012; 67:1146-51. [PMID: 22804789 DOI: 10.1111/j.1365-2044.2012.07267.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Stress increases cortisol and decreases testosterone. It is not known whether pain is affected by stress-related testosterone. Therefore, we investigated whether stress can affect pain perception by decreasing testosterone and increasing cortisol. Pain thresholds, pain and anxiety ratings and salivary testosterone and cortisol levels were measured in 46 healthy men during resting and stressful conditions. Pain was induced by electrical stimulation. Stress was induced by having participants perform a medical test. Stress significantly increased anxiety ratings and salivary cortisol levels, but decreased salivary testosterone levels. Stress also increased pain ratings and decreased pain thresholds. During stress, cortisol levels were negatively correlated with pain thresholds and testosterone levels were positively correlated with pain thresholds. Results indicated that testosterone can decrease and cortisol can increase pain induced by electrical stimulation, suggesting that acute clinical pain may be relieved by controlling stress and managing consequent stress-related testosterone and cortisol.
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Affiliation(s)
- J C Choi
- Department of Anesthesiology and Pain Medicine, Brain Research Group, Yonsei University Wonju College of Medicine, South Korea.
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