- Chen, Yanxia;
- Moutal, Aubin;
- Navratilova, Edita;
- Kopruszinski, Caroline;
- Yue, Xu;
- Ikegami, Megumi;
- Chow, Michele;
- Kanazawa, Iori;
- Bellampalli, Shreya Sai;
- Xie, Jennifer;
- Patwardhan, Amol;
- Rice, Kenner;
- Fields, Howard;
- Akopian, Armen;
- Neugebauer, Volker;
- Dodick, David;
- Khanna, Rajesh;
- Porreca, Frank
Pain is more prevalent in women for reasons that remain unclear. We have identified a mechanism of injury-free nociceptor sensitization and opioid-induced hyperalgesia (OIH) promoted by prolactin (PRL) in females. PRL signals through mutually inhibitory long (PRLR-L) and short (PRLR-S) receptor isoforms, and PRLR-S activation induces neuronal excitability. PRL and PRLR expression were higher in females. CRISPR-mediated editing of PRLR-L promoted nociceptor sensitization and allodynia in naïve, uninjured female mice that depended on circulating PRL. Opioids, but not trauma-induced nerve injury, decreased PRLR-L promoting OIH through activation of PRLR-S in female mice. Deletion of both PRLR-L and PRLR-S (total PRLR) prevented, whereas PRLR-L overexpression rescued established OIH selectively in females. Inhibition of circulating PRL with cabergoline, a dopamine D2 agonist, up-regulated PRLR-L and prevented OIH only in females. The PRLR-L isoform therefore confers protection against PRL-promoted pain in females. Limiting PRL/PRLR-S signaling pharmacologically or with gene therapies targeting the PRLR may be effective for reducing pain in a female-selective manner.