Pain and Hormones—Advances in Testing and Treatment

Author: Forest Tennant

Forest Tennant, MD, DrPH, FACPM, MPH

A number of factors have coalesced to make pain and hormones a topical issue in pain management.  One is that there are enough scientific studies to show us that pain itself has a dramatic effort on the hormone system.  It will deplete hormones, for example.  We also have learned that you can’t get good pain control unless the body has adequate levels of hormones, and sometimes the clinician will have to replace some of those hormones.  There’s also a group of hormones called neurohormones that have been discovered in the brain and that the brain uses them to protect itself and to heal its tissues and in certain pain states, we know that we’re going to have to regrow nerves to get good healing.

A major complication of long-term opioid therapy is suppression of the hormonal systems.  This means that we’re going to have to test for, and replace hormones in practically every patient who takes opioids on a daily basis.  Unfortunately, pain itself doesn’t have a number, and in medicine we’re used to measuring things by numbers. However, pain does cause effects on the hormone system or on inflammation that are measurable. Several markers have now been identified to help us, in effect, measure pain and we can’t know whether there our therapy is effective if we’re not measuring something objectively.  There’s another aspect to it and that is, these biomarkers also separate the drug user or the drug seeker away from the legitimate pain patient.

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