title: Allopregnanolone Levels Are Inversely Associated with Self-Reported Pain Symptoms in U.S. Iraq and Afghanistan-Era Veterans: Implications for Biomarkers and Therapeutics.
abstract: OBJECTIVE
  Pain symptoms are common among Iraq/Afghanistan-era veterans, many of whom continue to experience persistent pain symptoms despite multiple pharmacological interventions. Preclinical data suggest that neurosteroids such as allopregnanolone demonstrate pronounced analgesic properties, and thus represent logical biomarker candidates and therapeutic targets for pain. Allopregnanolone is also a positive GABAA receptor modulator with anxiolytic, anticonvulsant, and neuroprotective actions in rodent models. We previously reported inverse associations between serum allopregnanolone levels and self-reported pain symptom severity in a pilot study of 82 male veterans.
  
  
  METHODS
  The current study investigates allopregnanolone levels in a larger cohort of 485 male Iraq/Afghanistan-era veterans to attempt to replicate these initial findings. Pain symptoms were assessed by items from the Symptom Checklist-90-R (SCL-90-R) querying headache, chest pain, muscle soreness, and low back pain over the past 7 days. Allopregnanolone levels were quantified by gas chromatography/mass spectrometry.
  
  
  RESULTS
  Associations between pain ratings and allopregnanolone levels were examined with Poisson regression analyses, controlling for age and smoking. Bivariate nonparametric Mann–Whitney analyses examining allopregnanolone levels across high and low levels of pain were also conducted. Allopregnanolone levels were inversely associated with muscle soreness [P = 0.0028], chest pain [P = 0.032], and aggregate total pain (sum of all four pain items) [P = 0.0001]. In the bivariate analyses, allopregnanolone levels were lower in the group reporting high levels of muscle soreness [P = 0.001].
  
  
  CONCLUSIONS
  These findings are generally consistent with our prior pilot study and suggest that allopregnanolone may function as an endogenous analgesic. Thus, exogenous supplementation with allopregnanolone could have therapeutic potential. The characterization of neurosteroid profiles may also have biomarker utility.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Naylor
authors.forename: Jason D
authors.initials: JD
authors.lastname: Kilts
authors.forename: Steven T
authors.initials: ST
authors.lastname: Szabo
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Dunn
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Larry A
authors.initials: LA
authors.lastname: Tupler
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Shampine
authors.forename: Rajendra A
authors.initials: RA
authors.lastname: Morey
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Strauss
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hamer
authors.forename: H Ryan
authors.initials: HR
authors.lastname: Wagner
authors.forename: Christine E
authors.initials: CE
authors.lastname: Marx
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006261:Headache / Q000523:psychology*; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D011280:Pregnanolone / Q000627:therapeutic use*; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D014728:Veterans / Q000523:psychology
chemical_list: D015415:Biomarkers; D011280:Pregnanolone