Abstract
Background: Sex-differences in pain perception have been documented; however, the role of sex hormone levels in chronic musculoskeletal pain (CMP) remains unclear. Therefore, this study aimed to investigate whether endogenous sex hormone levels are associated with multisite and site-specific CMP.
Methods: We utilized data from a large population-based prospective cohort study (n=357,424; mean [SD] age, 56.5 [8.1] years; females [51.6%]). Serum levels of estradiol, testosterone, and sex hormone–binding globulin (SHBG) were measured at baseline. Musculoskeletal pain in the neck/shoulder, back, hip, knee, or ‘all over the body’ was assessed at baseline and subsequent three follow-ups. Chronic pain was defined if the pain had persisted for ≥3 months. Mixed-effects multinomial/logistic regression models were used for the analyses.
Results: In multivariable analyses, higher levels of testosterone were associated with a lower number of CMP sites in both females [OR=0.80 per SD, 95% CI (0.76, 0.83))] and males [0.81 (0.77, 0.86)]. Higher testosterone levels were associated with chronic pain in neck/shoulder, back, hip, and knee in both sexes (ORs ranged from 0.78–0.92 per SD). Neither estradiol nor SHBG levels were associated with number of CMP or site-specific CMP in both sexes, except for higher levels of SHBG being associated with neck/shoulder CMP in both sexes.
Conclusion: Greater testosterone levels were associated with a reduced number of CMP sites and site-specific CMP, while greater levels of SHBG were linked to lower odds of neck/shoulder CMP. These findings suggest a potential involvement of sex steroids in the pathogenesis of CMP.