Hormone Treatments in Chronic and Intractable Pain
by Forest Tennant MD, DrPH
Once chronic or intractable pain is reasonably well controlled, patient and physician
alike want some curative or permanent amelioration, in addition to symptom relief. To
date, some physical therapy techniques and possibly some nutritional supplements provide a
degree of permanent amelioration of pain, but these measures often fall short of wanted
results.
 Although early in what is clearly an emerging practice, some
hormone treatments appear — albeit based primarily as anecdotal reports — to
greatly enhance symtomatic pain control and possibly bestow some curative and ameliorative
properties. Basic science research on some hormones distinctly points out sound reasons
why some hormones should enhance pain treatment. Summarized here is a compilation of
hormone treatments and their rationale for current usage by pain physicians to compliment
their standard symptomatic treatments.
Definition of Hormone
For purposes here, a hormone is defined as a compound which is produced in a body organ
and secreted into the blood stream to perform some physiologic function(s). Some hormones,
such as gamma amino butyric acid (GABA) and pregnenolone are produced within neurons and
secreted into the blood as well as function within neurons as neurotransmitters.1-4
Why Are Hormone Treatments Needed?
Undertreated severe, chronic, and intractable pain depletes many hormones.5-8
With good pain control, some low serum hormone concentrations may return to normal.9
Some adrenal stress hormones, such as cortisol and adrenalin, may elevate in uncontrolled
pain as evidenced by tachycardia and hypertension. Prolonged hypercortisolemia produced in
severe, intractable pain may produce manifestations of Cushing’s disease including
osteoporosis, dental erosion, obesity, fatigue, and muscle wasting. Adrenal insufficiency,
with symptoms of Addison’s disease including cachexia, hypotension, electrolyte
depletion and muscle wasting, may occur as the adrenal gland exhausts. While severe,
chronic pain produces some hormone deficiencies, opioid administration may also suppress
pituitary excretion and worsen some hormone deficiencies, particularly testosterone and
possibly thyroid.10,11 Hormone treatments are basically given to replace those
that are depleted or suppressed by severe, chronic, or intractable pain and/or the
underlying disease. It may also be that intermittent supraphysiologic serum levels of some
hormones such as pregnenolone, adrenal androgens, GABA, human growth hormone, and
chorionic gonadotropin may promote healing of nerve and other soft tissues to permanently
reduce pain12-15 (see Table 1).
Please refer to the Apr/May 2005 issue for the complete text. In the event you need to order a back issue, please click here.
— Apr 2005
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