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Hormone Treatments in Chronic and Intractable Pain

An Emerging Practice
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Daily dosages of GABA, pregnenolone, androstenedione, and DHEA, have no labeled dosage levels and there are few reported, serious side-effects. Consequently, these hormones have been labeled as food supplements and are available without a doctor’s prescription.

Endocrinology Consultation

Physicians who are inexperienced or uncomfortable with hormone treatments should obtain consultation with an endocrinologist. The management of a patient who requires a hormone treatment with known side-effects — such as cortisone or growth hormone — may require co-management.

Pregnenolone

Basic science research shows that pregnenolone has many positive properties which suggest it should be almost a routine treatment in chronic and intractable pain.1-3,15-18 It is produced in the adrenal gland and central nervous system, and it is frequently referred to as a neurosteroid. It modulates GABA and NMDA receptors.2,17-18 Pregnenolone enhances cognitive and memory functions of the CNS.16,18,19 In the adrenals, ovary, and testicle, it is the precursor of all other hormones including cortisol, testosterone, and estrogen. Serum cholesterol is the substrate for pregnenolone (see Figure 1).

Figure 1. Adrenal Gland Hormone Synthesis. Note: the hormone synthesis above is similar in the ovary and testicle except that cortisol and aldosterone are not synthesized

This hormone might best be described as the “mystery hormone,” because it appears to have multiple, major physiologic roles in the body that are poorly understood. Amazingly, it is the most ubiquitous compound in the central nervous system. Some practitioners call it a “brain food” which may prevent dementia.13,16 Of particular relevance to pain treatment is that pregnenolone appears to have nerve construction properties, and it has shown ability to help heal spinal cord and sciatic nerve injuries in animals.13,14 Uncontrolled, intractable pain consistently suppresses pregnenolone production and produces low serum concentrations.

Once pain is controlled with opioids, serum pregnenolone normalizes. Pregnenolone supplements are inexpensive and appear very safe. There are no reported serious side-effects even with daily dosages of several hundred milligrams. The author uses a daily supplemental dose of 50 to 200mg per day in most intractable pain patients.

Patients usually report an enhanced feeling of well-being, increased energy, less depression, and better pain control. It is unknown, however, if pregnenolone may cause permanent healing of nerve tissue and permanent reduction in pan intensity, but research in animals suggests that this is a strong possibility.13,14

Adrenal Anabolic Androgens

The term anabolic means to construct tissue from basic elements. A steroid is a chemical structure related to cholesterol, which is the precursor of all adrenal and sex hormones. Healing and tissue construction requires adequate serum concentrations of the body’s natural anabolic, adrenal hormones, dehydroepiandrosterone (DHEA) and androstenedione. Treatment with anabolic adrenal steroids in pain states is not to be confused with their use in sports, which requires non-physiologic serum concentrations and excessive tissue growth.20,21 DHEA has several properties which should benefit pain patients. It is known, in many instances, to reduce abdominal fat, lower insulin resistance, relieve depression, and raise testosterone levels.22-26 It has been recommended, along with glucocorticoids, as a replacement in adrenal insufficiency which is common in intractable pan.22 Many poorly controlled, severe intractable pain cases demonstrate serum deficiencies of DHEA and androstenedione, and these deficiencies should be treated.

Androstenedione converts to testosterone, and serum testosterone levels rise within 30 minutes after androstenedione is ingested.27,28 Although androstenedione may have direct affects on muscle or other organs, it likely exerts its major affects in pain treatment as a precursor to testosterone.

There are few side-effects at daily dosages under 100mg. The most common is acne, which is a helpful indicator of excess dosage in pain patients.

Chorionic Gonadotropin (HCG)

Chronic gonadotropin is known to most practitioners only as the compound which elevates in pregnancy to construct and maintain the placenta. It is essential to realize that this understanding is far too narrow.

For example, body builders have long used this compound to develop the “cut muscle” appearance and to grow visible blood vessels. Weight control clinics have found it useful for many years. It is currently marketed for prepubertal cryptorchidism not due to obstruction and hypogonadotropic hypogonadism in males.

Based on the clinical experience of the author, HCG may have a definite place in treating some intractable pain patients whose pain is due to a variety of causes including fibromyalgia, neuropathies, and immune disorders. HCG is relatively inexpensive and has no known side-effects at recommended clinical dosages.

Knowledge of its physiology other than placental maintenance is incomplete. HCG is produced in the pituitary and its molecular structure is very similar to lutenizing hormone (LH), follicle stimulating hormone (FSH), and thyroid stimulating hormone (TSH). In fact, it is so similar that it will release testosterone and thyroid and raise serum levels of these and other hormones.29 HCG is found in a wide variety of normal tissues including testes, endometrium, kidney, liver, colon, gastric tissue, lung, spleen, heart, fibroblasts, and brain, but its precise physiologic impact on these tissues is not clear.

HCG is available as an intramuscular injection. To determine if it may be of clinical usefulness in pain patients, a therapeutic trial of 1cc or 1000 units should be given. HCG is found in serum at such low levels that testing for deficiencies is difficult and impractical at this time. HCG has a very long half life of about 24 hours. Consequently, the patient is able to report a positive, negative, or neutral clinical response following an injection. To date, responding patients report less pain, enhanced energy, improved strength, well-being, and sleep.

Last updated on: May 16, 2011
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