title: A novel use for testosterone to treat central sensitization of chronic pain in fibromyalgia patients.
abstract: Fibromyalgia is a diffuse chronic pain condition that occurs predominantly in women and may be under-reported in men. Symptoms include a loss of feeling of well-being and generalized widespread flu-like muscle aches and pain that fail to resolve due to central sensitization of nociceptive neurons. It has commonalities with a myriad of other chronic pain conditions which include PTSD, "Gulf War Syndrome", and various stress-induced conditions caused, for example, by viral infection, emotional or physical stress, trauma, combat, accident or surgery. It is not understood why some individuals are susceptible to this condition and others are not. White et al., elsewhere in this issue, present a clinical feasibility study designed to test the hypothesis that 1) low or deficient testosterone serum levels are linked to a high risk for an inflamed nociceptive nervous system and resultant chronic pain states, and 2) a testosterone transdermal gel applied once a day by fibromyalgia patients can be an effective therapeutic against chronic pain. Here, a short profile of fibromyalgia is provided along with a brief summary of best practices currently recommended by clinical specialists. The link between testosterone and pain is then discussed, with an overview of scientific studies that lay the foundation for testosterone as a possible important additional therapeutic that has the potential to be safely administered and effective but also avoid the adverse effects of other therapeutics. Finally, novel mechanisms by which testosterone therapy is likely to down-modulate pain signaling are proposed.
authors.affiliation: Department of Microbiology & Immunology, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA; White Mountain Pharma, 21 East 90th St, 8A, New York, NY 10128, USA. Electronic address: hillary.d.white@dartmouth.edu.
authors.forename: Hillary D
authors.initials: HD
authors.lastname: White
authors.affiliation: White Mountain Pharma, 21 East 90th St, 8A, New York, NY 10128, USA. Electronic address: drtomrobinson@aol.com.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Robinson
mesh_terms: D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D059333:Central Nervous System Sensitization / Q000187:drug effects; D059350:Chronic Pain / Q000188:drug therapy* / Q000378:metabolism; D005356:Fibromyalgia / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D013739:Testosterone / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D013739:Testosterone
keywords: Central sensitization; Chronic pain; Fibromyalgia; Inflamed nociceptive nervous system; Nociception; Stress; Testosterone