Hormone Therapy for Chronic Pain: Are Neurosteroids the Answer?

What every person living with chronic pain should know about steroids, replenishment, and what to ask their doctor.

Every individual living with chronic pain needs to know some fundamental facts about hormones. For starters, hormones are the chemicals that the body uses to protect and heal tissues. Second, if you have a pain problem that is severe enough to require daily medication such as pregabalin (eg, Lyrica), duloxetine (eg, Cymbalta), gabapentin (eg, Neurontin), or opioids, you may benefit from some hormone therapy, administered by an experienced provider.

While pain medication may provide you with you symptomatic, temporary relief so that you can function, hormone administration as part of a pain management plan can help to bring about the healing of damaged nerves and other tissues.

How Hormones Impact Pain: The Fight-or-Flight Response in Overdrive

When a person experiences continual pain, the body responds as if there is an emergency and exists in a constant state of alarm. The pain signals sent to the brain activate the endocrine system (that is, the collection of glands that produce hormones to help regulate metabolism, growth and development, and core functions such as sex, reproduction, sleep, and more) to mount the natural inborne “fight-or-flight response.”

This ancient mechanism, inherent in all life forms, provides a great advantage for handling emergencies, but when this system is activated on a daily basis from chronic unrelenting pain, this emergency system begins to tire and wear out.

The body’s built-in emergency system is clinically referred to as the hypothalamus-pituitary-adrenal system, or HPA axis. It is designed to respond to emergencies and danger by pumping out extra adrenaline and other hormones; after the crisis, the system quiets down, bringing homeostasis or balance back to the body. In cases of chronic pain, the over-ignition could be compared to having to drive a vehicle full speed through a blinding snowstorm for hours on end, which may be exhausting at best.

When the system is “on,” all of the body’s systems are in high alert: vison is acute, heart is racing, and breathing is rapid. Without any let-up, these systems begin to be affected in a negative way through over-stimulation and the intricate balance is lost.

For example, sleep may be lost due to over-stimulation of adrenaline and other stress hormones. Additional core systems may begin to wear down: immune, digestive, cardiovascular, connective tissue, muscle, bone, and even the brain. Cognitive function can become impaired and affect vision, hearing, memory, sexual function, and appetite. In many cases, individuals may overuse stimulants (eg, caffeine) to combat these states but this approach can actually further stress the system (see other common go-to’s that can make pain worse).

Another complicating factor contributing to hormone depletion can occur when someone is injured or has a genetic collagen disorder, such as Ehlers-Danlos (EDS) or Marfan Syndrome. With these conditions, intensive aerobic exercise can become difficult or impossible, and the benefits of the body’s own natural pain-relieving endorphin system become unavailable.

Supplementing the depleted hormones can, however, help to calm the body systems down enough to allow a profound healing process to begin. Function can be restored along with enhanced quality of life and a healthy restoration of vitality.

Supplementing the depleted hormones can, however, help to calm the body systems down enough to allow a profound healing process to begin. (Image: iStockPhoto)

Neurosteroids May Provide an Answer

A recent research discovery has shown that the brain and spinal cord (central nervous system, CNS) produce a set of hormones called “neurosteroids.” These hormones work to protect nerve cells in the CNS from being damaged by inflammation (which doctors may call “neuroinflammation”) that may result from trauma, infections, or pain itself. And, if nerve cells do get damaged in the CNS, neurosteroids attempt to regenerate them (called “neuroregeneration”).

Some of the neurosteroids, such as estradiol, progesterone, and dehydroepiandrosterone (DHEA) are generally known to the public, while others such as pregnenolone and allopregnanolone are not as well-known but are crucial to the treatment of individuals trying to manage chronic pain.

If you live with constant or intractable pain (that is, for more than 3 consecutive months), you may have developed a focus of neuroinflammation inside your CNS, and you may greatly benefit from one or more of these neurosteroids. The corticosteroids, methylprednisolone or dexamethasone, may be used at a higher “therapeutic” level for short periods of time to quell high levels of neuroinflammation, as they easily pass the blood-brain barrier and thus, pose little risk.

Ask your doctor or pain specialist whether trialing neurosteroids may be beneficial to your particular chronic condition.

Don’t Fear the Word “Steroid”

Unfortunately, the term “steroid” has become a pejorative or negative term among the general public. In many cases, people assume steroid involves cortisone or a cortisone derivative. The well-publicized abuse of some hormones, called “anabolic steroids” by athletes for tissue enhancement or to boost athletic performance, has further given the term “anabolic” a negative image.

In the authors’ view, this fear is unfounded. Natural steroids are only dangerous and lead to negative side effects when used in high, regular dosages. The truth is that almost all hormones used in pain care are “steroids,” and they can be taken in a safe and effective manner when physicians, patients, and families know both the scientific facts about them and are clear that their safe clinical usage in pain care is on a low-dose, intermittent basis.

Steroid hormones are generally named by the gland and/or tissue that produces them. (Image: iStockPhoto)

Technically speaking, “steroid” is a term for a chemical structure made up of multiple “benzene rings” (a series of carbon and hydrogen atoms). It might surprise you to know that the most plentiful “steroid” in the body is cholesterol and that many hormones used in medicine are derivatives of cholesterol, including vitamin D, testosterone, estrogen, progesterone, aldosterone, cortisol and thyroid hormones. Cortisol is another steroid that lives naturally in the bloodstream and spinal fluid; it helps with metabolism and immune response.

Steroid hormones are generally named by the gland and/or tissue that produces them. Adrenal or corticosteroids, for instance, are made in the adrenal gland and derived from cortisol while sex steroids are made in the gonads (ovary and testicle). As noted, neurosteroids are made in the CNS while anabolic steroids are those that grow or regenerate tissue.

Why Hormones Should Matter to Pain Patients and What to Ask Your Doctor

Individuals living with chronic pain need to know the following:

  1. Steroid hormones can help to heal and grow tissue.
  2. If you want to permanently reduce your pain, you may benefit from taking one or more steroid hormones to treat the basic cause of your pain.
  3. Steroid hormones can be administered safely and effectively by a clinician if they are taken in low, intermittent dosages.
  4. Hormone therapy as a treatment option is just beginning to enter pain practice so it’s important to do your research and as your doctor about whether steroid hormones may work for you.

Curative Versus Symptomatic

It’s also important to understand whether a prescribed medication is meant to “curative” or “symptomatic.” When you think “symptomatic,” think temporary relief that does not last long while curative refers to healing and, thus, a reduction of the damaged or “diseased” state causing your pain.

Practically speaking, most medications prescribed for pain tend to be “symptomatic” and do not provide curative or long-lasting effects. Hormones, on the other hand, are described as “curative.” This term does not mean the therapy will cure you but rather that the agent has potential to heal some tissue and, thus, permanently reduce your pain.

Which Hormones to Replenish or Replace

Replenishment may be essential to healing and recovery if a neurosteroid hormone is deficient in the serum.The blood panel of hormones that is generally recommended for testing contains cortisol, DHEA, estradiol, pregnenolone, progesterone, and testosterone. If any of these hormones are identified as low, they may be able to be replenished by a low, intermittent oral dose of the deficient hormone, typically3 to 5 days a week. Replenishment is crucial because the body is unable to do much healing if it has a low hormone. In addition, normal hormone levels may assist symptomatic pain medication give you more relief. Once the blood shows a normal level, hormone replenishment may be stopped.

Hormone replacement is quite different. This is the process in which a gland is diseased and cannot produce enough hormones for normal physiologic functions. Hormone replacement is almost always daily and may last a lifetime.

Overall, if you require daily medication to control chronic pain, you may benefit from hormone therapy. Some specific hormones may give you a curative effect and permanently reduce your pain. Ask your doctor whether this potentially game-changing approach may be right for you as part of your treatment plan.

Updated on: 06/23/20
Continue Reading:
Patient Primer: Hormone Therapy for Chronic Pain