Hormone Therapies: Newest Advance in Pain Care
Severe, uncontrolled pain may exhaust the adrenal gland, resulting in low levels of pregnenolone and cortisol. While adequate pain control will usually normalize serum hormone levels, opioid-induced suppression of the system may require additional treatment.
The effect of severe, persistent pain on the hormone system is profoundly negative.1-5 If the patient’s hormone system is not kept homeostatic and balanced, the patient with pain will rapidly age and deteriorate. Episodic excess of cortisol in the blood, which occurs during pain flares, is particularly deleterious. Consequently, the achievement of hormonal balance—not too high or too low—has to be a primary goal of treatment.
Unfortunately, some of the potent pain medications, particularly opioids, may suppress the production of some adrenal and gonadal hormones, especially testosterone and pregnenolone, and need to be replaced
In addition to replacing those hormones that become depleted during therapy, some specific hormones have anabolic and regenerative properties and are emerging as effective adjuncts in advancing pain care
Basic Hormone Functions
Relative to pain relief, adrenal and gonadal hormones have two other functions. They migrate from the glands and help to provide pain relief as well as serve many emotional and intellectual functions.
Pain Is a Stressor
Fundamental to understanding the relationship between pain and the body’s hormone (endocrine) system is to simply realize that there is no greater stress than pain. Along with such bodily insults as fright, shock, trauma, and surgery, pain causes an activation and stimulation of the hypothalamus–pituitary–adrenal/gonadal system
At the time of activation, high levels of these hormones can be detected in the serum, saliva, and urine.
Severe pain and adrenal exhaustion produce a “vegetative” state (see Table 2). This state, in its severest form, can result in electrolyte depletion, cardiovascular collapse, and death if undiagnosed and untreated.
Characteristically, the patient exhibits a blank stare, looks straight ahead, and walks and talks slowly. Blood pressure may be low, but there may be a high pulse rate. Patients have no appetite and may take refuge in bed or on a couch, as movement or any sensory input, including light and sound, enhance their pain
Patients complain of severe fatigue, lethargy, and weakness.
It is often said that pain ages people. One major, if not the most critical, element in pain’s physiologic insults and progressive deterioration is episodic hypercortisolemia. Even while in opioid treatment, pain that flares or breaks through a medicinal barrier will elevate serum cortisol
It is the biochemical and tissue-degenerative changes caused by excess cortisol in the blood that are threats to patients with pain.