Journal of Rehabilitation Research & Development (JRRD)

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Volume 53 Number 4, 2016
   Pages 499 — 510

Abstract — An exploratory pilot investigation of neurosteroids and self-reported pain in female Iraq/Afghanistan-era Veterans

Jennifer C. Naylor, PhD;1–2 Jason D. Kilts, PhD;1–2 Jennifer L. Strauss, PhD;1–2 Steven T. Szabo, MD, PhD;1–2 Charlotte E. Dunn, BA;1 H. Ryan Wagner, PhD;1–2 Robert M. Hamer, PhD;3† Lawrence J. Shampine, BS;1–2 Joseph R. Zanga, MD;4 Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup; Christine E. Marx, MD1–2*

1Research and Development/Mental Health Services, Durham Department of Veterans Affairs Medical Center (VAMC), Durham, NC; and Veterans Integrated Service Network-6 Mid-Atlantic Mental Illness, Research, Education and Clinical Center, Durham VAMC, Durham, NC; 2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; 3Departments of Psychiatry and Biostatistics, University of North Carolina, Chapel Hill, NC; 4Ambulatory Care Service Line and Mental Health Care Service Line, Durham VAMC, Durham, NC

Abstract — Female Veterans are the most rapidly growing segment of new users of the Veterans Health Administration (VHA), and a significant proportion of female Veterans receiving treatment from VHA primary care providers report persistent pain symptoms. Currently, available data characterizing the neurobiological underpinnings of pain disorders are limited. Preclinical data suggest that neurosteroids may be involved in the modulation of pain symptoms, potentially via actions at gamma-aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA) receptors. Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) are neurosteroids that modulate inhibitory GABA receptors and excitatory NMDA receptors, producing complex neuronal effects. Emerging evidence from male Iraq/Afghanistan-era Veterans suggests that reductions in neurosteroid levels are associated with increased pain symptoms and that neurosteroids may be promising biomarker candidates. The current exploratory study thus examined associations between self-reported pain symptoms in 403 female Iraq/Afghanistan-era Veterans and serum DHEAS and DHEA levels. Serum DHEAS levels were inversely correlated with low back pain in female Veterans (Spearman r = –0.103; p = 0.04). Nonparametric analyses indicate that female Veterans reporting moderate/extreme low back pain demonstrated significantly lower DHEAS levels than those reporting no/little low back pain (|Z| = 2.60; p = 0.009). These preliminary findings support a role for DHEAS in pain physiology of low back pain and the rationale for neurosteroid therapeutics in pain analgesia.

Key words:Afghanistan, back, biomarker, dehydroepiandrosterone, dehydroepiandrosterone sulfate, DHEA, DHEAS, female, Iraq, low back pain, neurosteroid, novel, pain, therapeutic, Veteran.


View HTML ¦ View PDF ¦ Contents Vol. 53, No.4

This article and any supplementary material should be cited as follows:
Naylor JC, Kilts JD, Strauss JL, Szabo ST, Dunn CE, Wagner HR, Hamer RM, Shampine LJ, Zanga JR; Department of Veterans Affairs Mid-Atlantic Mental ??Illness Research, Education, and Clinical Center Workgroup; Marx CE. An exploratory pilot investigation of neurosteroids and self-reported pain in female Iraq/Afghanistan-era Veterans. J Rehabil Res Dev. 2016;53(4):499–510.
http://dx.doi.org/10.1682/JRRD.2014.11.0294
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