217: Influence of anabolic androgenic steroids on pain modulation

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Assessment and Measurement of Pain/Nociception, Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia)

Background and Aims: The non-therapeutic use of anabolic androgenic steroids (AAS) has increased among recreational athletes. However, their effects on nociceptive processing remain unclear. While supraphysiological testosterone exposure has been associated with antinociceptive properties, potential phase-dependent alterations in pain modulation during AAS cycles have not been sufficiently examined. This preliminary within-subject analysis from an ongoing longitudinal study investigated the influence of AAS on pain modulation.

Methods: This study is part of the longitudinal SOS cohort (Study of Steroid Abusers). Participants were recruited via digital media, training centres, and snowball sampling. Eligible individuals were men and women aged ≥15 years, without therapeutic indication for anabolic androgenic steroids (AAS), willing to initiate a supraphysiological AAS cycle. Ethics approval was obtained. Assessments were performed by a trained examiner in a controlled setting. Quantitative sensory testing included: pressure pain threshold (PPT) using a digital algometer; temporal summation of pain (TSP) with 10 repeated stimuli rated on a 0–10 scale; and conditioned pain modulation (CPM) using a standardised pressure cuff paradigm.

Results: Linear mixed models showed a reduction in PPT (-1.00 kgf/cm2; 95% CI -1.98 to -0.01) at the post-cycle period compared to the pre-cycle period (baseline). During ASS use (50% of the cycle), TSP increased (1.10 pain intensity points in a 0-to-10 scale; 95% CI 0.02 to 2.17) and CPM reduced (-0.75 kgf/cm2; 95% CI -1.43 to -0.08) compared to the pre-cycle period. These findings indicate increased pain sensitivity and/or reduced pain endogenous inhibitory control during and after AAS cycles.

Conclusions: These preliminary findings suggest that AAS may influence nociceptive processing. Increased pain sensitivity during and after ASS use may be a result of short-term modulation of pain threshold and/or adaptive modulation of inhibitory pathways. Although exploratory, these findings provide evidence on neurophysiological consequences of supraphysiological ASS exposure and their potential implications for pain modulation.

Key words: Pain Threshold; Pain Measurement; Athletes; Sports Medicine; Neurophysiology.

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Presenting Author: Eduardo Penna
Submitting Author: Eduardo Penna

Senior Author: Luiz Hespanhol

IASP 2026 Global Year theme of Neuropathic Pain: No

• Rafaela Firmino de Almeida: Master of Science - Department of Physiotherapy, Speech Therapy, and Occupational Therapy, Faculty of Medicine, University of Sao Paulo (USP), Brazil, Centre of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo (USP), Brazil.
• Raissa Beatriz Souza Silva: NA - Department of Physiotherapy, Speech Therapy, and Occupational Therapy, Faculty of Medicine, University of Sao Paulo (USP), Brazil
• Andresa Rossilho Casale: Master of Science - Centre of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo (USP), Brazil.
• Rafael de Almeida Azevedo: Doctor of Philosophy - Centre of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo (USP), Brazil.
• Hamilton Roschel: Professor, PhD - Centre of Lifestyle Medicine; Laboratory of Assessment and Conditioning inRheumatology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo (USP), Brazil, Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculty of Medicine, University of Sao Paulo (USP), Brazil.
• Bruno Gualano: Professor, PhD - Centre of Lifestyle Medicine; Laboratory of Assessment and Conditioning inRheumatology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo (USP), Brazil, Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculty of Medicine, University of Sao Paulo (USP), Brazil.
• Luiz Hespanhol: Professor, PhD - Department of Physiotherapy, Speech Therapy, and Occupational Therapy, Faculty of Medicine, University of Sao Paulo (USP), Brazil, Centre of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo (USP), Brazil.