Chronic pain occurs with greater frequency in women, with a parallel sexually dimorphic trend reported in sufferers of many autoimmune diseases. There is a need to continue examining neuro-immune-endocrine crosstalk in the context of sexual dimorphisms in chronic pain. Several phenomena in particular need to be further explored. In patients, autoantibodies to neural antigens have been associated with sensory pathway hyper-excitability, and the role of self-antigens released by damaged nerves remains to be defined. In addition, specific immune cells release pro-nociceptive cytokines that directly influence neural firing, while T lymphocytes activated by specific antigens secrete factors that either support nerve repair or exacerbate the damage. Modulating specific immune cell populations could therefore be a means to promote nerve recovery, with sex-specific outcomes. Understanding biological sex differences that maintain, or fail to maintain, neuroimmune homeostasis may inform the selection of sex-specific treatment regimens, improving chronic pain management by rebalancing neuroimmune feedback. Given the significance of interactions between nerves and immune cells in the generation and maintenance of neuropathic pain, this review focuses on sex differences and possible links with persistent autoimmune activity using sciatica as an example.

中文翻译：

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神经（自身）免疫和慢性坐骨神经疼痛的性别差异


慢性疼痛在女性中发生的频率更高，许多自身免疫性疾病患者也有类似的性别二态性趋势。有必要在慢性疼痛的性别二态性背景下继续检查神经-免疫-内分泌串扰。有几个现象特别需要进一步探讨。在患者中，针对神经抗原的自身抗体与感觉通路过度兴奋有关，而受损神经释放的自身抗原的作用仍有待确定。此外，特定的免疫细胞会释放直接影响神经放电的促伤害性细胞因子，而被特定抗原激活的T淋巴细胞会分泌支持神经修复或加剧损伤的因子。因此，调节特定的免疫细胞群可能是促进神经恢复的一种手段，并具有性别特异性的结果。了解维持或无法维持神经免疫稳态的生物性别差异可能有助于选择特定性别的治疗方案，通过重新平衡神经免疫反馈来改善慢性疼痛管理。鉴于神经和免疫细胞之间的相互作用在神经性疼痛的产生和维持中的重要性，本综述以坐骨神经痛为例，重点关注性别差异以及与持续性自身免疫活动的可能联系。