 |
Staying Healthy Today With Kirk Hamilton
June 11, 2010
Intractable Pain and Hormone Therapy
My recent interview with Dr. Forest Tennant, MD, DrPH an "intractable pain" specialist, internist, and addictionologist was quite thought provoking. I learned some new things and relearned some old things in a different light. It also "challenged" my thinking a bit. This interview is a must read/listen for any clinician or lay person dealing with chronic pain. I have experience with intermittent pain in patients, but I have virtually no experience with "intractable" pain. Pain that comes generally from permanent nerve damage and is present 24/7.
The first thought that ‘juggled' my thinking is that in these types of patients pain medicine is absolutely necessary, usually opioids, to breaking the chronic and exhausting cycle of unrelenting pain, not only for pain sake, but also to preserve, repair and restore hormone (endocrine) function that is chronically taxed by the stress of chronic pain. In short, 6-8 weeks of excellent pain control by opioids and other medications is needed to start balancing, or calming, the endocrine system that has been either chronically heightened (Phase I), or has finally crashed (Phase II) by the stress of unrelenting pain. This includes the pituitary, adrenal and gonadal (testes, ovaries) axis. The realization that you can damage tissue in these organs, including the brain, from unrelenting pain that might not be reparable was a new realization for me. Thinking about chronic pain triggering a chronic "fight or flight" response was also different. Blood pressure and pulse going up initially. Sometimes heart palpitations. Hormones and their effects initially being high, and then becoming exhausted with associated hormone deficiency symptoms. Either heightened activation or exhausation can be harmful to health.
I first became interested in interviewing Dr. Tennant because of his article entitled, "Hormone Replacement and Treatments in Chronic Pain" Update 2010, in Practical Pain Management, January/February, 2010; 26-40. A theme I got from Dr. Tennant, aside from the specific uses of hormones, is this field of chronic pain management has to include hormonal therapy. And if you are looking for a good pain management doctor, not an interventionist that does nerve blocks only, but someone who manages pain medically, you should be looking for someone who has experience with using hormones and medications together.
Assessing hormones was pretty basic from Dr. Tennant's point of view. He uses traditional serum lab testing for a.m. cortisol, testosterone, DHEA and pregnenolone. If testosterone is low it is replaced with either a patch or by injection. Fifty milligram per day or so if patches are used. DHEA is used in 50-100 mg per day oral doses. DHEA is generally purchased over-the-counter and the goal is to raise blood levels into the normal range. Pregnenolone is one of Dr. Tennant's favorite therapies. It is the precursor to all the major hormones. It is critical for the brain, and may be the hormone in highest quantity in the brain. It can help with normalizing the levels of the other down-line hormones as well. Again 50-100 mg per day, or more, of over-the-counter pregnenolone is very important to helping chronic intractable pain patients. Dr. Tennant emphasized the virtues and safety of pregnenolone (and safety of the other hormones as well). Dr. Tennant also was using more progesterone in chronic pain with a "twist" for all of us "bio-identical" folks. He found taking synthetic medroxyprogesterone orally 10-20 mg per day, or better yet, compounding a cream out of it and putting it over the area of pain, especially with ionophoresis, was bringing about excellent and pleasantly surprising results. He also stated over-the-counter creams of natural progesterone probably weren't strong enough. He noted that progesterone therapy can also increase the levels of estrogen and testosterone, and in some cases he has had testosterone levels normalize in subjects after progesterone therapy. Personally I am not a big fan of medroxyprogesterone and probably would try a very strong concentration of a compounded progesterone cream (i.e. 100 mg/gm). But you can't knock success. The last hormone that Dr. Tennant talked about was HCG (human chorionic gonadotrophin) which most people know about from being produced during pregnancy from the placenta. But it is also produced by the pituitary gland in males and females, and increases the production of testosterone, estrogen, progesterone and thyroid, and reduces pain possibly through tissue healing and neurogenesis. Dr. Tennant was very enthusiastic about HCG's role in intractable pain either by injection or by a compounded formula taken by nasal inhalation. His monografts Human Chorionic Gonadotropin in Pain Management and The Intractable Pain Patient's Handbook for Survival are must reads for anyone interested in pain control. He has an excellent list of articles on this subject (Click Here).
As far as diet goes he recommends a very high protein diet (50% protein) and minimal refined carbohydrates to provide amino acids for neurotransmitters that get depleted in chronic pain, amino acids for tissue repair, and to control blood sugar which tends to be a significant issue in chronic opioid patients. While I understand the rationale of amino acid precursors for neurotransmitters and tissue repair, and the importance of controlling blood sugar, I don't think the way he goes about it is the only way, or even the best way. But again, you can't knock success and I don't have experience with intractable pain patients. I would be more cautious on the type of protein (more plant than animal), and, if animal protein was consumed I would encourage more cold water fish and free-ranged animals versus factory farmed meats and cheeses which have more pro-inflammatory fatty acid profiles. In addition you can control blood sugar fluctuations by a whole food, plant-based diet equally as well...if not better than a high protein diet. That said, the emphasis on having enough high quality protein on board for tissue repair, neurotransmitter synthesis and maintenance of an even blood sugar cannot be under-emphasized.
His basic supplement regimen in these chronic pain patients is a good multivitamin/mineral; calcium, magnesium and vitamin D; pregnenolone; GABA, taurine and glutamine.
This is an information ‘loaded' interview. It is very educational for both the clinician and lay person. I highly recommend going to the links in his bio to review his ancillary writings and articles which add a lot to his interview.
‘Recent' Staying Healthy Today Show Interviews
Intractable Pain And The Important Role Of Hormone Therapy - An Interview With Forest Tennant, MD, DrPH
Heart Disease Prevention And Reversal With The New Cardiology - An Interview With Stephen Sinatra, MD
'New' Expert Pearls - Potential Therapies In Nutritional Medicine at Prescription2000.com by Kirk Hamilton
More than 1500 one line protocols from more than 900 Expert Interviews with links to Pub Med and Vitasearch. com
Adenomatous Polyps - Eicosapentaenoic Acid - 47914
Eicosapentaenoic acid (EPA) at one gram twice daily with meals of a 99% EPA supplement. [Gut, 2010 March 26; [Epub ahead of print]. 47914 (6/2010)] Summary Interview PubMed
Platelet Aggregation - Omega-3 Fatty Acids - 47903
Omega-3 fatty acid ethyl esters containing 465 mg eicosapentaenoic acid (EPA) and 375 mg docosahexaenoic acid (DHA) (1 capsule) in the morning after breakfast augmented the reduction in platelet aggregation of aspirin and clopidogrel with mild but no additional side effects.[J Am Coll Cardiol, 2010 April 10, 55(16):1671-8. 47903 (5/2010)] Summary Interview PubMed
Sepsis - Fish Oil - 47796
Fish oil given parenterally in a 50:40:10 mixture of medium-chain fatty acids, soybean oil and fish oil reduced interleukin-6 in the blood, improved lung function and shortened hospital stay.[Critical Care, Jan 19, 2010;14:R5. 47796 (5/2010)] Summary Interview PubMed
New Expert Interviews at VitaSearch.com by Kirk Hamilton
Adenomatous Polyposis (FAP) and Eicosapentaenoic Acid (EPA), Professor Mark Hull, United Kingdom, 7/2010
Percutaneous Coronary Intervention, Antiplatelet Therapy and Omega-3 Fatty Acids, Grzegorz Gajos MD, PhD, Poland, 6/2010
Sepsis, Inflammation and Fish Oil, Philip C. Calder, Ph.D., United Kingdom, 6/2010
Staying Healthy Webinar Series With Kirk Hamilton at EnergeticNutrition.com
Completed 6 part webinar series is available for FREE in video, audio or for download the webinar. Topics include: Staying Healthy Principles, Diabetes, Obesity, Heart Disease and Healthy Aging.
Staying Healthy Today - Current Nutrition & Prevention Research
Bladder Cancer - Intake Of Cruciferous Vegetables Modifies Bladder Cancer Survival.
Breast Cancer - Meta-Analyses Of Lignans And Enterolignans In Relation To Breast Cancer Risk.
Cholesterol - Short-Term Effect Of Cocoa Product Consumption On Lipid Profile: A Meta-Analysis Of Randomized Controlled Trials.
Cholesterol - Plant Stanols Dose-Dependently Decrease LDL-Cholesterol Concentrations, But Not Cholesterol-Standardized Fat-Soluble Antioxidant Concentrations, At Intakes Up To 9 G/D.
Diabetes - Diabetes And Cancer: A Consensus Report.
Heart Attack - Adherence To The Southern European Atlantic Diet And Occurrence Of Nonfatal Acute Myocardial Infarction.
Heart Function - The Mediterranean Diet Contributes To The Preservation Of Left Ventricular Systolic Function And To The Long-Term Favorable Prognosis Of Patients Who Have Had An Acute Coronary Event.
High Blood Pressure - Salt Sensitivity Is Associated With Insulin Resistance, Sympathetic Overactivity, And Decreased Suppression Of Circulating Renin Activity In Lean Patients With Essential Hypertension.
Lung Cancer - Serum B Vitamin Levels And Risk Of Lung Cancer.
Obesity - Resveratrol Regulates Human Adipocyte Number And Function In A Sirt1-Dependent Manner.
Organic Foods - Nutrition-Related Health Effects Of Organic Foods: A Systematic Review.
Polycystic Ovary Syndrome (PCOS) - Effect Of A Low Glycemic Index Compared With A Conventional Healthy Diet On Polycystic Ovary Syndrome.
Weight Gain - Meat Consumption And Prospective Weight Change In Participants Of The EPIC-PANACEA Study.
If you enjoy this Free newsletter please send this LINK to a friend.
Remember Until Next Time, Stay and Be Well.
Kirk
Kirkhamilton@prescription2000.com
www.prescription2000.com
Staying Healthy Today With Kirk Hamilton Archives
Staying Healthy Today Interview Archives
Staying Healthy Today Interview Transcripts
Staying Healthy Today Webinars
Expert Pearls
Expert Interviews
Your Subscription:
[SUBSCRIPTIONS]
|
|
