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Identifica tion and Management of Cardiac -Adrenal-Pain Syndrome

Severe, chronic, under-treated pain may produce cardiac and adrenal complications, that in some pain patients, can lead to premature death.
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Summary

Severe chronic pain may produce cardiac and adrenal complications which is referred to herein as “Cardiac-Adrenal-Pain Syndrome.” The presence of this syndrome should clearly signal to the practitioner that the patient’s pain is so severe as to over-stimulate the heart and adrenal glands to produce complications which may produce severe pathology and even death. Although there are sophisticated tests which may more clearly elucidate pain’s impact on the heart and adrenal glands, simple pulse rate, blood pressure, and an early morning assay of cortisol and pregnenolone can provide rapid, clinical identification of the syndrome. If it is present, aggressive measures must be taken to control the pain lest further complications as a result of pain itself, will develop. It may be necessary to use ancillary medications to lower elevated blood pressure or pulse rate in addition to supplementing hormone deficiencies.

This syndrome may produce complications not yet fully appreciated. There are few clinical conditions that produce chronic tachycardia. This complication may lead to a wide variety of cardiac disorders including angina, athecosclerosis, congestive heart failure, arrhythmias, and sudden death. Abnormal glucocorticoid levels in excess or deficiency are known to produce, among other complications, profound impacts on the immune system and skeletal structure.

Due to the very serious ramifications of the cardiac-adrenal-pain syndrome, it is highly recommended that physicians test for blood pressure, pulse rate, and cortisol/pregnenolone levels in all chronic, severe pain patients and aggressively treat pain to ameliorate such complications.

Acknowledgement

The studies reported here would not have been possible without the outstanding dedication of Laura Herman, RN, NP.

Last updated on: May 16, 2011
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