Editor’s Memo November 2017: Dr. Tennant opens an overdue discussion on the history and future of pain medication alternatives.
…the pharmacologic properties of almost all of the currently available analgesics were established and clinically implemented more than a century ago.
Yet, a safe and effective option with a unique pharmacologic mechanism that has been right in front of us — oxytocin — has emerged as an excellent pain reliever.
To most, oxytocin is known as the love hormone, as this naturally occurring substance has been recognized for its favorable role in social bonding and sexual pleasure.
More recent evidence has focused on the role of oxytocin in protecting the nervous system during times of stress so that individuals remain in place rather than flee
Relief Far Beyond the Most Common Use
Our growing understanding of this neurotransmitter-acting hormone has led to an appreciation of its involvement in the modulation of both physiologic and emotional functionality.
I could sure use some better “emotional functionality” now that the DEA is breathing down my neck.
Perhaps oxytocin could shore up my battered emotional resilience, which has been worn down by fear and apprehension of the next doctor’s appointment, wondering if I’ll still be able to get pain relief from my doctor.
Research has yielded ample proof of its role as an efficacious nociceptive agent with great potential for pain management far beyond its more traditional use in childbirth.
Given the urgent, public health need for immediately available opioid alternatives to meet the needs of our chronic pain patients, I along with a few colleagues, have been working hard to determine appropriate formulations, dosages, and clinical applications for oxytocin.
#It will be hard for Dr. Tennant to work on this now that he’s being persecuted by the DEA. (See DEA Raids Dr. Forest Tennant’s Pain Clinic)
I take this opportunity to draw attention to the clinical evidence that supports the suitable use of oxytocin for long-term relief of chronic pain. It is time we herald oxytocin as a very favorable pain management alternative to opioids.
Understanding the pain-relieving potency of oxytocin has its basis in our understanding of the maternal bond.
Social scientists recognized and demonstrated the function of oxytocin as the natural driver sustaining women through the painful process and suffering of childbirth.
it seems that the use of oxytocin to produce uterine contractions, induce delivery, and initiate post-birth nurturing has skewed, even limited, the pain management community into viewing it as useful for this singular purpose
By considering synthetic oxytocin as a one-purpose medication, practitioners have undermined the vast pain-relieving potential of this neurohormone.
In effect, oxytocin is the body’s most potent, natural pain modifier, not just for labor and delivery, but also for many types of chronic pain.
Basic science as well as clinical experience now supports a clear mechanism for oxytocin as a major, natural pain-reducing agent that is released when a person sustains a fall, experiences a trauma, or suffers from other painful events
Potent, Effective Opioid Alternative
Ongoing studies have been elucidating the routes of action to explain the ways in which the hormone, oxytocin, may act as a powerful pain reliever with opioid potency.
At times of stress or pain, surges of oxytocin are released into the peripheral nervous system
Oxytocin receptors also are located at multiple sites in the brain and throughout the spinal cord
In addition to activating its own receptors and decreasing pain signals, oxytocin binds to opioid receptors and stimulates endogenous opioid release in the brain. (See The endogenous opioid system)
Oxytocin also stimulates cannabinoid receptors and is known to relieve pain as well as induce a feeling of calm, and lower serum cortisol, stress, and anxiety
Besides its analgesic capability to lessen pain during labor, growing evidence of oxytocin has been reported to relieve the pain associated with
- chronic back pain,
- irritable colon, and
While administering exogenous oxytocin does not remain in serum longer than a few minutes, it is able to cross the blood-brain barrier, enter the spinal fluid, and stimulate multiple receptors long after it is likely to be measurable in the serum.
Although the literature commonly refers to its application via the intranasal route, it may also be effective when administered sublingually (buccal route) as a liquid, dissolvable tablet, or troche.
Dosages of 20 to 80 international units (IU) will usually lessen chronic pain within five to 15 minutes.
Pain relief may be sustained for two to four hours, while some patients have reported being pain free for as long as six to eight hours.
We have administered oxytocin to patients who also were taking ketamine, low dose naltrexone, benzodiazepines, neuropathic agents, and opioids, with no observed or reported adverse reactions.
We have prescribed it both as a regular pain lowering, maintenance agent and for pain flares in lieu of an opioid.
My patients with chronic pain conditions have received instructions to take oxytocin two to three times a day. The potency of oxytocin is the equivalent of about 30 mg of oxycodone or morphine.
Not a Magic Bullet, But a Great Option
It is important to acknowledge that oxytocin, as is the case with any pain reliever, will not produce pain relief in every patient.
The pain-relieving ability of this hormone will likely vary from patient to patient, and its effectiveness undoubtedly will be related to intrinsic blood levels, sex, and pain severity, among others factors known and unknown.
Oxytocin is a hormone with a strong, pain-reducing potential that represents a relatively safe alternative to opioids for some patients.