Neuroinflammation: Treating the Underlying Cause of Chronic, Severe Pain – Tori Rodriguez, MA, LPC – September 08, 2017
I’m pleased that EDS is known, at least to some doctors, to be so painful that it qualified for Dr. Tenant’s short list of “pathologic conditions that cause the most persistent or constant pain”:
“Neuroinflammation due to microglial activation is the underlying cause of severe persistent or constant pain, and unless it is suppressed, no real treatment of the cause of pain can be realized,” Dr Tennant told Clinical Pain Advisor.
“Time has taught us that there is a relatively short list of pathologic conditions that cause the most severe, chronic pain — every pain practitioner should have awareness of these,” he added.
These conditions include Ehlers-Danlos syndrome, sickle cell disease, Lyme disease, and severe peripheral neuropathies.
Dr Tennant also gave examples of pathologic consequences and symptoms of neuroinflammation, including
- constant pain,
- central sensitization with allodynia and hyperalgesia, and
- febrile heat episodes.
Here are the 4 components of treatment for centralized pain and neuroinflammation:
- Pain relief using standard nonpharmacologic and pharmacologic approaches
- Neuroinflammation control with varying combinations of low-dose corticosteroids, anti-inflammatories, microglial suppressors, and nutritional supplements
- Spinal fluid flow exercises including walking arm swings, upper body gyration, and deep breathing. [see also Ehlers-Danlos and Cerebrospinal Fluid Problems]
- Neuroregeneration with B12 [see Proton pump inhibitors and B12 deficiency], replenishment of hormones showing low serum levels, and the administration of neurohormones that have been found to produce neuroregeneration in animal studies — for example, oxytocin, human growth hormone, and human chorionic gonadotropin
According to Dr Tennant, there is a large body of animal and in vitro research on neuroregeneration and hormonal suppression of neuroinflammation, and results have been positive among the few clinical researchers who have applied the basic science findings to real patients
He recommends clinical trials with neurohormones in motivated patients whose pain is reasonably under control.
“It is too early to recommend a specific clinical indication, but the neurohormones appear quite safe and I believe astute practitioners should begin using neurohormones,” he added.
He stated that neither FDA approval of these agents nor a consensus on evidence-based practice in this area is likely, as pharmaceutical companies will not spend money on large trials since hormones cannot be patented, and they have not been in use long enough to accumulate much evidence-based data.
He distributed references to give practitioners confidence that prescribing neurohormones is not a “pie-in-the-sky” concept.
- Tennant F. Neuroinflammation: treating the underlying cause of chronic, severe pain. Presented at Pain Week 2017; September 5-9, 2017; Las Vegas, NV.
- Graeber MB, Christei MJ. Multiple mechanisms of microglia: a gatekeeper’s contribution to pain states. Exp Neurol. 2012; 234(2):255-61. doi:10.1016/j.expneurol.2012.01.007
- Gwak YS, Hulsebosch CE. Remote astrocytic and microglial activation modulates neuronal hyperexcitability and below-level neuropathic pain after spinal injury in rat. Neuroscience. 2009;161(3):895-903. doi:10.1016/j.neuroscience.2009.03.055
- Lei ZM, Rao CV. Neural actions of luteinizing hormone and human chorionic gonadotropin. Semin Reprod Med. 2001;19(1):103-9. doi:10.1055/s-2001-13917
Author: Dr Tennant is Editor in Chief of the journal Practical Pain Management, and is a speaker for Regenesis Biomedical.