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Prolactin: A New Actor in Musculoskeletal Physiology and its Implication in Orthopedic Pathologies

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Original Article | Vol 5 | Issue 1 |  January-June 2025 | page: 14-18 | Paul Germán Terán Vela, Estefanía Anabel Lozada Tobar, Luis Eduardo Guzmán Freire

DOI: https://doi.org/10.13107/jrs.2025.v05.i01.161

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 10 May 2025, Review Date: 20 May 2025, Accepted Date: May 2025 & Published: 30 Jun 2025

Author: Paul Germán Terán Vela [1], Estefanía Anabel Lozada Tobar [1], Luis Eduardo Guzmán Freire [2]

[1] Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito- Ecuador,
[2] Orthopedic Specialties Center, Quito-Ecuador.

Address of Correspondence
Dr. Paul Germán Terán Vela,
Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito-Ecuador.
E-mail: paulteranmd@gmail.com

Abstract
Prolactin (PRL), traditionally known for its role in lactation, has emerged as a pleiotropic hormone with actions that extend beyond reproduction. Growing evidence suggests its involvement in pain modulation, immune function and tissue homeostasis, with potential repercussions on musculoskeletal health. This review analyzes in depth the available scientific literature on PRL and its relationship with orthopedic pathologies, including chronic pain, tendinopathies, and conditions of the muscle, ligaments, and articular cartilage. The molecular and cellular mechanisms underlying the influence of PRL on musculoskeletal physiology are explored, as well as the clinical implications of its level disturbances, both hyperprolactinemia and hypoprolactinemia. Finally, future perspectives and lines of research are discussed to fully understand the role of PRL in the context of orthopedic pathologies are discussed.
Keywords: Prolactin, Hyperprolactinemia, Hypoprolactinemia, Chronic pain, Tendinopathies, Osteoarthritis, Skeletal muscle, Ligaments, Articular cartilage, Prolactin receptors

References:

1. Noel GL, Suh HK, Stone JG, Frantz AG. Human prolactin and growth hormone release during surgery and other conditions of stress. J Clin Endocrinol Metab 1972;35:840-51.
2. Sassin JF, Frantz AG, Weitzman ED, Kapen S. Human prolactin: 24-Hour pattern with increased release during sleep. Science 1972;177:1205-7.
3. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, et al. Diagnosis and treatment of hyperprolactinemia: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:273-88.
4. Molitch ME. Drugs and prolactin. Pituitary 2008;11:209-18.
5. Bostwick JR, Guthrie SK, Ellingrod VL. Antipsychoticinduced hyperprolactinemia. Pharmacotherapy 2009;29:64-73.
6. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML. Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 1989;70:145-60.
7. Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline comparative study group. N Engl J Med 1994;331:904-9.
8. Maciuba S, Bowden GD, Stratton HJ, Wisniewski K, Schteingart CD, Almagro JC, et al. Discovery and characterization of prolactin neutralizing monoclonal antibodies for the treatment of female-prevalent pain disorders. MAbs 2023;15:2254676.
9. Singh S, Kopruszinski CM, Watanabe M, Dodick DW,Navratilova E, Porreca F. Female-selective mechanisms promoting migraine. J Headache Pain 2024;25:63.
10. Clevenger CV, Furth PA, Hankinson SE, Schuler LA. The role of prolactin in mammary carcinoma. Endocr Rev 2003;24:1-27.
11. Ling C, Hellgren G, Gebre-Medhin M, Dillner K, Wennbo H, Carlsson B, et al. Prolactin (PRL) receptor gene expression in mouse adipose tissue: Increases during lactation and in PRLtransgenic mice. Endocrinology 2000;141:3564-72.
12. Guler HP, Zapf J, Froesch R. Short-term metabolic effects of recombinant human insulin-like growth factor I in healthy adults. N Engl J Med 1987;317:137-40.
13. Lubberts E, Joosten LA, Oppers B, Van Den Bersselaar L, Coenen-De Roo CJ, Kolls JK, et al. IL-1-independent role of IL-
17 in synovial inflammation and joint destruction duringcollagen-induced arthritis 1. J Immunol 2001;167:1004-13.
14. Schlechte JA, Shermanf BM, Chapler FK, Van Gilder J. Long term follow-up of women with surgically treated prolactinsecretingpituitary tumors. J Clin Endocrinol Metab1986;62:1296-301.
15. Klibanski A, Zervas NT. Diagnosis and management ofhormone-secreting pituitary adenomas. N Engl J Med 1991;324:822-31.
16. Yun SJ, Sang H, Park SY, Chin SO. Effect ofhyperprolactinemia on bone metabolism: Focusing onosteopenia/osteoporosis. Int J Mol Sci 2024;25:1474.
17. Buvat J, Lemaire A, Buvat-Herbaut M, Fourlinnie JC,Racadot A, Fossati P. Hyperprolactinemia and sexual functionin men. Horm Res 1985;22:196-203.
18. Szewczyk AK, Ulutas S, Aktürk T, Al-Hassany L, Börner C,Cernigliaro F, et al. Prolactin and oxytocin: Potential targets formigraine treatment. J Headache Pain 2023;24:31.

How to Cite this article: Terán Vela PG, Tobar EAL, Freire LEG | Prolactin: A New Actor in Musculoskeletal Physiology and its Implication in Orthopedic Pathologies| Journal of Regenerative Science | Jan-Jun 2025; 5(1): 14-18.

 

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Extracorporeal shock wave treatment in plantar fasciitis with an associated neuropathic component. How to optimize the result?

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Case Report | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 21-23 | Lauro Schledorn de Camargo , Ricardo Kobayashi
DOI: 10.13107/jrs.2022.v02.i02.59

Author: Lauro Schledorn de Camargo [1], Ricardo Kobayashi [2]

[1] Orthopedic Surgeon at LC Clinic, Jundiai-SP Brazil, Brazil,
[2] Pain Center, Department of Neurology, University of São Paulo, Brazil.

Address of Correspondence
Dr. Lauro Schledorn de Camargo, MD,
Orthopedic Surgeon at LC Clinic, Jundiai-SP Brazil, Brazil.
E-mail: laurosch@hotmail.com

Abstract

Introduction: Current evidence supports the use of radial pressure wave and focused extracorporeal shock wave treatment (ESWT) for the treatment of chronic plantar fasciitis that does not improve with conservative treatment. Studies show that a quarter of plantar fasciitis may have an associated neuropathic component and the literature shows that neuropathic pain causes more intense pain and greater functional disability. However, there is a lack of literature on the results of ESWT in tendinopathies associated with the neuropathic pattern.
Case report: We report a case of plantar fasciitis with central sensitization and associated neuropathic component. At first, pregabalin 75mg twice a day was used, which improved the neuropathic pattern. After that, 3 sessions were performed with piezoelectric ESWT with energy of 0.12 mJ/mm2, 2000 impulses at a frequency of 8 Hz, once a week for three weeks. The patient was followed up for 3 months and had complete improvement of symptoms without functional limitation for activities of daily living.
Conclusion: This case report serves to draw attention to the importance of evaluating and treating the neuropathic pattern associated with tendinopathies in order to optimize the therapeutic result. However, randomized clinical trials are lacking to determine the real difference in results between using ESWT in nociceptive pain or in mixed pain with an associated neuropathic component.

Keywords: Chronic pain, plantar fasciitis, mixed pain, neuropathic pain, shockwaves.

References:

1. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. J Bone Joint Surg Am. 2018 Feb 7 ; 100 (3):251-263. doi:10.2106/JBJS.17.00661.
2. Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD. American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. J Foot Ankle Surg. 2018 Mar-Apr;57(2):370-381. doi: 10.1053/j.jfas.2017.10.018.
3. Wheeler PC. Neuropathic pain may be common in chronic lower limb tendinopathy: a prospective cohort study. Br J Pain. 2017 Feb;11(1):16-22. doi: 10.1177/2049463716680560.
4. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (Dn4). Pain. 2005 Mar;114(1-2):29-36. doi: 10.1016/j.pain.2004.12.010.
5. Santos JG, Brito JO, de Andrade DC, Kaziyama VM, Ferreira KA, Souza I, Teixeira MJ, Bouhassira D, Baptista AF. Translation to Portuguese and validation of the Douleur Neuropathique 4 questionnaire. J Pain. 2010 May;11(5):484-90. doi: 10.1016/j.jpain.2009.09.014.
6. Maki M, Ikoma K, Kido M, Hara Y, Sawada K, Ohashi S, Kubo T. Magnetic resonance imaging findings of chronic plantar fasciitis before and after extracorporeal shock wave therapy. Foot (Edinb). 2017 Dec;33:25-28. doi: 10.1016/j.foot.2017.10.002.
7. Wheeler PC. Up to a quarter of patients with certain chronic recalcitrant tendinopathies may have central sensitisation: a prospective cohort of more than 300 patients. Br J Pain. 2019 Aug;13(3):137-144. doi: 10.1177/2049463718800352.
8. Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers. 2017 Feb 16;3:17002. doi: 10.1038/nrdp.2017.2.
9. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010 Sep;17(9):1113-e88. doi: 10.1111/j.1468-1331.2010.02999.x.
10. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015 Feb;14(2):162-73. doi: 10.1016/S1474-4422(14)70251-0.
11. Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, Gollwitzer H. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med. 2008 Nov;36(11):2100-9. doi: 10.1177/0363546508324176.
12. Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouché RT, Caminear DS, Fullem B, Vester JC, Horn C, Banke IJ, Burgkart R, Gerdesmeyer L. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am. 2015 May 6;97(9):701-8. doi: 10.2106/JBJS.M.01331.
13. Morrissey D, Cotchett M, Said J’Bari A, Prior T, Griffiths IB, Rathleff MS, Gulle H, Vicenzino B, Barton CJ. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med. 2021 Oct;55(19):1106-1118. doi: 10.1136/bjsports-2019-101970.

 

How to Cite this article: Camargo Lsd, Kobayashi R |Extracorporeal shock wave treatment in plantar fasciitis with an associated neuropathic component. How to optimize the result?. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 21-23.

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