Abstract
BackgroundLow cortisol levels are associated with several functional pain syndromes. In patients with secondary adrenal insufficiency (SAI), the lack in endogenous cortisol production is substituted by the administration of oral hydrocortisone (HC). Our previous study showed that a lower dose of HC led to an increase in reported subjective pain symptoms. Whether different doses of HC substitution alter somatosensory functioning in SAI patients has not been established yet.MethodsIn this randomized double blind cross-over trial, forty-six patients with SAI participated. Patients randomly received either first a lower dose (0.2–0.3 mg HC/kg body weight/day) for 10 weeks followed by a higher dose (0.4–0.6 mg HC/kg body weight/day) for another 10 weeks, or vice versa. After each treatment period, blood samples were drawn and somatosensory functioning was assessed by determining the mechanical detection threshold (MDT), mechanical pain threshold (MPT), mechanical pain sensitivity (MPS) and the pain pressure threshold (PPT), according to the Quantitative Sensory Testing (QST) battery by the German Network on Neuropathic Pain.ResultsThe administration of the higher dose of HC resulted in significantly higher levels of cortisol (mean [SD] 748 [245] nmol/L) than the lower dose (537 [250] nmol/L, P<0.001). No differences were found in MDT, MPT, MPS and PPT z-scores between the two doses of HC. Furthermore, the number of patients showing sensory abnormalities did not differ between the two different doses.ConclusionsThe results suggest that the dose of HC has no impact on somatosensory functioning in response to mechanical stimuli in patients with SAI, despite previously found altered subjective pain reports.
Highlights
Stress hormones are known to play an important role in stress-related bodily disorders, such as functional pain syndromes
Blood samples were drawn and somatosensory functioning was assessed by determining the mechanical detection threshold (MDT), mechanical pain threshold (MPT), mechanical pain sensitivity (MPS) and the pain pressure threshold (PPT), according to the Quantitative Sensory Testing (QST) battery by the German Network on Neuropathic Pain
No differences were found in MDT, MPT, MPS and PPT z-scores between the two doses of HC
Summary
Stress hormones are known to play an important role in stress-related bodily disorders, such as functional pain syndromes. Activation of the HPA axis results among others in the secretion of cortisol. Patients with fibromyalgia showed reduced 24 h-urinary cortisol excretion compared to healthy controls [4,5,6]. Reduced cortisol levels might disinhibit the secretion of inflammatory mediators and thereby promote the sensitization of peripheral or central nociceptive neurons [8]. It was found that higher cortisol levels are associated with decreased pain thresholds [9] and increased pain sensitivity in response to thermal stimuli [10]. Other studies were unable to find an effect of cortisol levels and pain sensitivity [11]. Low cortisol levels are associated with several functional pain syndromes. Whether different doses of HC substitution alter somatosensory functioning in SAI patients has not been established yet.
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