Fibromyalgia & Chronic Pain LIFE Spring 2015, Issue 11 | Page 10

Professional Medical Advice

Table 3
Hormone Effects on Pain and Healing
Decreases Inflammation

Promotes Regeneration of Tissues

Enhances Natural Pain Relief

Enhances Prescribed Medication

Protects Tissues from Injury
particularly opioids, are required
with hormone replacement.

in energy, sleep, mood, endurance,
and mental functions. (Table 2)

HOW PAIN DEPLETES
HORMONES
Severe pain is fundamentally severe stress. It stimulates the hypothalamus and pituitary in the
brain to produce extra hormones
in an effort to eliminate the cause
of pain. There is a rise in some serum hormones which may include
cortisol, thyroid, pregnenolone,
dehydroepiandrosterone (DHEA),
progesterone, testosterone, estrogen, and corticotropin (ACTH). If a
hormone profile is taken and there
are elevations of some of these hormones, it means that pain needs to
be better controlled. If pain persists over a long period, such as a
few weeks, the hypothalamus, pituitary, adrenal, thyroid, or gonadal
glands may not be able to keep up
production, so serum levels of some
hormones will drop below normal.
In this situation the astute pain
physician will realize that not only
is better pain control likely to be a
necessity, but deficient hormones
will need to be at least temporarily replaced as optimal pain control
is difficult to achieve if any major
hormone is deficient. Table 1 lists
the hormones that may be depleted
in chronic pain. Fibromyalgia patients are advised to have their physicians order a hormone profile and
replace those found to be deficient.
With hormone replacement most
pain patients report not only better pain control but improvements

CAUTIONS WITH HORMONE
REPLACEMENT
There is some fear among physicians and patients regarding hormone replacement. The origin
of the fear primarily stems from
the use of synthetic estrogen and
cortisone preparations that were
administered in prior years to patients without the benefit of blood
testing. In fact, until recently the
majority of hormone administration was done without the benefit of blood testing. The problem with hormone administration
without proper testing is that administration of any hormone that
raises blood levels above the norm
for an extended time period may
result in cancer or other medical
complications.

10  Fibromyalgia & Chronic Pain

Life

To avoid medical complications
hormones should not be given
unless there is a documented deficiency by laboratory test. Also,
there must be follow-up testing
to make sure that hormone blood
levels remain normal and that too
much hormone is not being taken.
Another safety factor championed
by many physicians including this
author is use of bioidentical hormones rather than synthetic hormones. In my opinion, the body
will better keep bioidentical hormones in normal serum-range than
is often the case with synthetic

Sp r i n g 2 0 1 5

hormones. Also, it is believed that
bioidentical hormones will be less
likely to overstimulate tissue and
cause complications, including cancer. Simply put, the real “stuff ” is
safer than synthetic hormones.
WHAT WE DON’T KNOW
Although it is clear that hormone
testing and replacement is a necessity for optimal pain care, there
are many unknowns. For example,
should hormones be attempted in
fibromyalgia patients before starting anti-depressants, anti-inflammatory, neuropathic, or opioid
agents? Should hormones be attempted before the standard fibromyalgia drugs such as milnacipran,
(Savella®), pregabalin (Lyrica®),
and duloxetine (Cymbalta®) be attempted? Should they be used in
combination or even used preferentially. The same question can be
said for opioids.
Also unclear, is how long replacement of hormones should be done.
Clinical experience to date suggests
that once hormones are brought into
normal serum range it may not be
necessary to continue replacement.
Replacement may serve as a “jump
start.” Some fibromyalgia patients
may, however, have to maintain hormone replacement for life. The use
of low dosages of hydrocortisone and
thyroid in the absence of low blood
levels is controversial and the benefits
of long-term maintenance is unclear.
Researcher and
clinician Dr. Forest Tennant has
a private clinic
in Covina, CA;
editor of
Practical Pain
Management.
Author of The
Intractable Pain
Patient’s Handbook for Survival. For more information, please see foresttennant.com