Editor's Memo
by Forest A. Tennant, MD, DrPH
 Recently it has become abundantly
clear that persistent pain produces a cascade of complications independent of the basic
underlying cause of the pain. A major effect of severe pain is on the endocrine system.
Pain acts as a severe stressor on the entire hypothalmic-pituitary-end organ system.
Consequently, multiple hormone levels — including cortisol, adrenalin, thyroid,
insulin, estrogen, and testosterone — may be altered.
In this edition, Oliver and Taylor highlight the ubiquitous problem of male sexual
dysfunction in pain patients. While male sexual dysfunction may have multiple causes, the
problem of low testosterone levels in male and female pain patients is a grave cause for
concern. So much so, that rehabilitative and palliative pain specialists must now
seriously consider routine serum testosterone screening and replacement. One only need
look at the reasons anabolic steroids, which are testosterone and its derivatives, are
taken by athletes to understand the practical, clinical need for testosterone replacement.
Strength, endurance, healing, energy, and pain relief are the reasons that anabolic
steroids are used in sports, so their necessity in pain treatment — particularly in
pain patients with a low serum level — is obvious.
At this time we are just learning about hypotestosteronemia in pain patients. It
appears to be a combination of direct pain effects on the
pituitary-adrenal-testicular-axis as well as biochemical suppression of testosterone
production by therapeutic agents. It is clear that severe persistent pain patients
deteriorate over time and demonstrate osteoporosis, teeth erosion, muscle atrophy,
weakness, decreased libido, and immune deficiencies. Just how much of this adverse cascade
of events is related to hypotestosteronemia is unclear, but it is clearly time to move the
pain field from arguments such as opioid dosages and abuse, to preventing the
complications of severe pain.
Forest A. Tennant, MD, DrPH
Editor in Chief
Please refer to the Sep/Oct 2003 issue for the complete text. In the event you need to order a back issue, please click here.
— Sep/Oct 2003
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