Abstract
The relationship between corticosteroids (endogenous and exogenous) and stress is
well known, as is the use of steroids as concomitant treatment in pain management
during acute inflammation. In the past, steroids have not been considered the first
line of treatment in pain management. In this review, we examine new scientific and
clinical evidence that demonstrates the direct role that steroids play in the generation
and clinical management of chronic pain. We will discuss the new findings demonstrating
the fact that steroids and related mediators produce paradoxical effects on pain such
as analgesia, hyperalgesia, and even placebo analgesia. In addition, we will examine
the physiologic effect of stress, high allostatic load, and idiopathic disease states
such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and burnout.
The recently observed positive relationship between glutaminergic activity in the
insula and clinical pain will be examined in the context of understanding the central
role of steroids in chronic pain. The complex role of the hypothalamic-pituitary-adrenal
axis in pain will be discussed as well as other heterogeneous forms of chronic pain
that involve many components of the central nervous system. Components of the hypothalamic-pituitary-adrenal
axis have paradoxical effects on certain types of pain that are dependent on dose
and on site (whether peripheral or central) and mode of application. Recent studies
on glia have shown that they prolong a state of neuronal hypersensitization in the
dorsal root ganglia by releasing growth factors and other substances that act on the
immune system. We will discuss the implication of these new findings directly linking
pain to steroids, stress, and key higher brain regions in the context of future therapeutic
targets.
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Article info
Footnotes
Publication of this article was supported by the Collège International de Recherche Servier (CIRS).
STATEMENT OF CONFLICT OF INTEREST: The authors have nothing to disclose.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
