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