At age 31, after medical school, surgical residency, and two years of a plastic surgery fellowship, you get run over by an 8-year-old while removing your skis at Heavenly Valley in South Lake Tahoe. You have fractures in your L4-L5 vertebrae and a herniated disc space at L5-S1.

The pain was and is unbearable. Stand for more than two minutes, and your legs and feet go numb. You endure three surgeries, countless hours of physical therapy, acupuncture, massage, hyperbaric oxygen, and learn kundalini yoga and qi gong. Nothing helps. You’ve traveled to an ashram in India to seek spiritual help.

Ten years of training and your plastic surgical career is over before it began.

Except for a few blissful hours, with three different narcotics, the electric shocks running up and down your spine live on. Besides costing a fortune, modern medicine’s answer is to shuffle, or rather, “refer,” you from one doctor and pain clinic to another.

You have a record of narcotics seeking your state’s mandatory scheduled drug usage list. The “establishment” now classifies you as a “drug seeker.”

Your bride takes the children, the house, the car, and the golden retriever home to her mother. When you arrived at your parent’s home, the divorce papers were waiting for you in the room you grew up in.

When you can, you walk with a cane. Sometimes, you use a walker to help you stay upright. Your parents, who raise the All-American boy, lead in the school show, football team quarterback, and 4.0 GPA in college, can’t believe and don’t accept your new normal.

Moving Out, Going Down

“Take your pitiful, woe-is-me attitude and get out,” Mom said, pointing to the door. “Dad,” I pleaded.

But Dad only looked down at the floor, never looking me in the eye.

The only way to get you through the day is by downing the oxys, which are getting harder and harder. You have gained over one hundred pounds in the eighteen months since the accident.

When the ‘rents tossed you, you could only afford a seedy third-floor walk-up apartment on short notice and with limited physical capacity.

Suicide enters your mind.

You call a former roommate “Doctor Bob,” who is now a psychiatrist. Bob was a wildman in college and med school. He was, in a word, crazy. Hence the nickname “Crazy Bob.” You told him he went into psychiatry to fix himself, and he agreed. He offers you another antidepressant and two antipsychotic medications.

“You know they have black box warnings on them,” You say to Bob, “about increasing suicide ideation.”

“I know,” he replied. “But look at you. You are fat. You are a diseased dumpster fire of a human. The only exercise you get is flinging empty pizza boxes frisbee-like into the trash. You’re out of breath as soon as you cross the room. You spend all day watching TV. You are a cauldron of inflammation, and I’m supposed to cure you with pills. Ain’t gonna happen, buddy. How do you stand yourself? Take the pills and shut your yap.”

“Thank you, Mister warmth and understanding,” you reply. Not.

Two (more) antidepressants and another antipsychotic agent. Adding those to the three narcotics you already have and seven medications to counteract the side effects of the first five meds makes a total of thirteen medications, thirty-four doses per day.

Society expects you to be responsible and function. You miss several rent payments, and now there’s a ‘three-day to pay or quit’ notice on your front door. You celebrate by going to a big box store, grabbing a pre-baked chicken, and walking out without paying. Sirens go off. Security rushes over. You are busted.

From a plastic surgery fellow to a nearly homeless shoplifter. All due to a kid not looking where he was going and ramming you from behind. (And to add insult to injury, even though you were standing still with one ski off, the kid’s mother blames you and is suing you for the kid’s head injury. After all, you are a rich doctor.)

Ray of Hope

Can it get any worse? Of course, but you are pretty far down the rabbit hole already. And like the proverbial song, in this dark moment, as you wait for Mom and Dad to bail you out, dawn breaks.

Getting arrested, in hindsight, was the best thing to happen to you since skiing that day. The cops took your pills away, and in short order, the pain and then the withdrawal fiercely kicks in. The jailers summon the prison nurse who listens to your story and, after prescribing enough ‘hillbilly heroin’ to ease the pain, gives you an independent “referral.”

“I was there,” she said, “in your shoes at once. I was twenty-six. Started noticing a bulging in my lower belly. Every quack this side of the Pecos told me I had everything from irritable bowel syndrome to uterine fibroids to functional dysbiosis, whatever that is. I got pills, shots, scopies, you name it. No one expects a twenty-six-year-old to have uterine cancer. I found an anti-aging ob-gyn online who finally figured it out. Came across her looking for alternative medical docs, and she got burned for prescribing Ivermectin, you know, the crime of the century, during Covid.”

“Now,” she continued, “You need to be a realist. Even alternative docs have their limits. Whichever way you go, your back will still be broken, and your surgeries will still be failed. But instead of more OCs and psych meds, and then more pills to counteract the side effects from the first seven, anti-aging, or some of them refer to themselves as functional medical practitioners, step back and take a look at the whole picture.

Nurse Dobbs slips you a note before you are sprung. It was the best advice you ever received.

Now, every Tuesday at 8 PM Eastern, 5 PM Pacific, you are, without fail, in front of a computer or on your phone listening to the seminars by the American Osteopathic Society of Integrative Medicine (AOSIM). The AOSIM is a group of physicians, physician assistants, nurses, nurse practitioners, chiropractors, naturopaths, lay people, and even a few close-your-ear establishment medicine types, homeopaths, dedicated to healing. The horror.

Every week since October 2020, the AOSIM has hosted practitioners worldwide who showcase the latest cutting-edge innovations in alternative and complementary medicine. (Zoom link: https://us02web.zoom.us/meeting/register/tZAtde-upjgtEtLTA35oyb9WDXtB5MwDSQ2z)

Who knew that stealing that chicken would save you and change your world? In November 2023, you, the AOSIM, presented a series of lectures on Basic Hormone Replenishment for Men and The Endocrinology of Pain Management. You listen

The speaker describes your symptoms almost to a “T.” You learned about handling all of your problems within a “hormone-centric” lens, i.e., an intersection of endocrinology and pain management. In short, optimizing your hormones is a critical component of treating chronic pain effectively.

Not one of those fancy-panted specialists from the university ever mentioned hormones at all…

The Hormone Centric Picture of Pain

Pain is a symptom and a significant stressor that disrupts the pituitary-adrenal axis. This interruption of your hormonal homeostasis leads to a substantial increase in cortisol, the stress hormone. Widespread physiological turmoil ensues.

Additionally, opioids uniquely impact hormonal balance, further complicating the body’s response to pain. Sustained opioid pain control induces an opioid ‘endocrinopathy’ resulting in:

(1-2)

1. Suppressed LH/FSH
2. Low testosterone (Suppression of gonadotropin-releasing hormone in 75-85% of patients
3. Low estradiol
4. Amenorrhea/oligomenorrhea (females)
5. Gynecomastia (males)
6. Impotence

The hormones involved in opioid endocrinopathy are HCG, HGH, Testosterone, Pregnanalone, Progesterone, Androstenedione, and DHEA. ⁽³⁾

The Importance of Hormone Testing ⁽⁴⁾

Testing hormone levels provides valuable insights into pain management. Hormone evaluation is critical for:

1. Biomarkers for Pain: Hormone levels are independent biomarkers highlighting uncontrolled pain and complications arising from hormone deficiencies, excesses, or imbalances.
2. Monitoring Recovery: Hormone balance indicates recovery progress, helping clinicians adjust treatment protocols effectively.
3. Identifying Underlying Issues: Hormonal imbalances complicate pain management, making hormone testing a vital component of a comprehensive pain management strategy.

Candidates for Hormone Evaluation ⁽⁵⁾

Not every patient experiencing pain requires a full hormonal assessment. However, specific populations are more likely to benefit from this evaluation, including those with:

• Constant, unrelenting pain
• Disability and reclusiveness
• Severe Insomnia
• Medication Seekers
• Early Refill Requesters
• Distraught family members
• Hypertensive, Tachycardic Individuals
• Anorexia
• Depression, Crying Spells, Hopelessness
• Constantly Seeking the “Next Cure”

Neurosteroids: A Special Focus ^(6-10)

Neurosteroids, hormones that cross the blood-brain barrier to “fine-tune” the balance between the excitatory and inhibitory neurotransmitters glutamate and GABA, respectively, play a crucial role in regulating pain. The major neurosteroids are cortisol, testosterone, pregnenolone, progesterone, HCG, DHEA, estradiol and oxytocin. Failure of the neurosteroid system results in erratic brain transmissions expressed as depression, suicide, anxiety, panic attacks, phobia, and psychosis.

Neurosteroids aid in managing anxiety, enhancing cognitive functions, exerting analgesic effects through the regulation of pain receptors, and suppressing neuroinflammation.

Essential Hormones in Pain Management

The major neurosteroid hormones include:

Major Hormones:

• Cortisol regulates stress and immune responses. Chronic pain causes excessive cortisol production, leading to: ⁽¹¹⁾
  • Sleep disorders
  • Sugar cravings
  • Decreased efficiency
  • Fat deposits
  • Osteoporosis, Arthritis, Muscle Pain
  • Fatigue
  • Increase in blood pressure
  • Increase in cholesterol and triglycerides
  • Water retention
  • Increase in blood sugar
  • High blood pressure
  • Thinning skin, Hair loss
  • Loss of muscle mass
  • Anxiety, feelings of stress
  • Abdominal weight gain
• Testosterone: Low levels are equal ^(12-18)
  • Weak, flabby muscles,
  • Anxiety,
  • Depression
  • Poor sense of self-worth,
  • Low libido
  • Increased pain sensitivity and mood disorders.
  • Weight gain
  • Opioids decrease testosterone levels by up to 50% within two hours of ingestion.
    • Opioids decrease testosterone levels in up to 86% of patients with adequate opioid pain control via an increase in prolactin and a resulting suppression of LH and FSH.
    • 87% of men on long-term opioids with adequate pain control experience new onset erectile dysfunction.
    • 52% of women on long-term opioids with adequate pain control experience suffer from a new onset lack of libido.
  • In men:
    • Hydrocodone, oxycodone, and morphine reduce free testosterone
    • Methadone, fentanyl, tramadol, and non-opioids, gabapentin and pregabalin, have no effect.
  • In women:
    • Hydrocodone, oxycodone, morphine, and pregabalin have no impact on free estrogen levels
    • Tramadol, fentanyl, and gabapentin significantly reduced levels of free estrogen.
• Pregnenolone blocks the effects of cortisol, is a (calming) GABA-A receptor antagonist, and is critical for adequate memory. ⁽¹⁹⁾

Symptoms of low pregnenolone include: ⁽²⁰⁾

• Loss of short-term memory
• Brain Fog
• Anxiety
• Poor Concentration
• Poor Pain Control
• Depression
• Reduced Perception of Bright Colors
• Pessimism
• Arthritis
• Insomnia
• Autoimmune Diseases
• Estrogen Dominance
• Mood Disorders
• Social Phobias
• Progesterone receptors are present in peripheral and central glial cells. ⁽²¹⁾ Progesterone and its metabolite, Allo-Progesterone, are diminished in chronic pain scenarios. ⁽²²⁾

Symptoms of low progesterone are: ^(23-24)

Memory Loss

Slowed Thought Process Headache

Impulse Aggression Decreased Comprehension

Anxiety, Irritability/Nervousness, Mood Changes

Insomnia

Emotional Flatness Breast Swelling Suicide Ideation

Bloating/Peripheral Edema Osteoporosis/Bone Loss Uterine Fibroids

Ovarian Cysts/Endometriosis Excessive Menstrual Bleeding Decreased HDL

• HCG (Human Choriogonadotropin), the so-called “pregnancy” hormone, is continuously produced in the pituitary gland in both women and men. HCG is not confined to pregnant patients.
• HCG:
  • Acts as a major hormone stimulator of testosterone, thyroid, estradiol, progesterone, and cortisol hormones.
  • Possesses androgenic effects ^(25-26)
  • Consists of Two Subunits
    • Alpha-Structurally similar to LH, FSH, and TSH
    • Beta-Adrenergic-Activates Cyclic-AMP, which produces Nitric Oxide, dramatically enhances blood flow. ⁽²⁷⁾
  • The effect of adequate HCG is:
    • Increased energy, pain control, and libido.
    • Reduced opioid dosages and improved sleep.
    • Neutralization of the opioid endocrinopathy (reduction) of testosterone
    • Pain Control Through Neurogenesis and Tissue Healing
  • Dose
    • 500-1000 iu SQ 1-3 X/Week or
    • 250-500 IU Sublingual Liquid 1-3x/week

• DHEA is the most abundant hormone in the male and female body ⁽²⁸⁾. DHEA:
  • Regulates estrogen and testosterone.
  • Balances cortisol
    • Administering DHEA to a patient with high cortisol levels will lower the stress hormone in a dose-dependent fashion.
  • Enhances immune function.
  • Prevents diabetes.
  • Facilitates weight loss.
  • Plays a significant role in bone health and mood disorders.
  • Suppresses IL- 10 Derived Pain in SLE (At high dose of 200 mg/d) ⁽²⁹⁾
  • Is neuroprotective by converting to estradiol and testosterone
    • Inhibits TNF-a and CNS inflammatory markers.
    • DHEA inhibits the production of monocytes, astrocytes, and microglia. ⁽³⁰⁾
  • Low levels of DHEA are associated with chronic pain and headache.
  • S/S DHEA Deficiency ^(31-32)

• Chronic pain
• Headache
• Depression
• Poor Stress Management
• Lack of Stamina
• Moodiness
• Osteoporosis, Bone, Joint, Muscle Pain
• Memory Loss

• Thyroid Hormones are your “gas pedal.” They regulate every metabolic function and are considered a “Goldilocks” hormone. We need not too much, not too little—just the right amount. The thyroid’s role in pain regulation is biphasic.
  • Acute pain stimulates the production of thyroid hormones, leading to hyperthyroid _S/S. (33)
  • Severe intractable pain suppresses pituitary hormones, including TSH, leading to hypothyroidism. ⁽³⁴⁾
• Symptoms of hypothyroidism include dry skin, dry hair, fingernails that crack and break, constipation, weight gain with an inability to lose weight, cold intolerance, and constant fatigue (as opposed to intermittent fatigue throughout the day, which is indicative of cortisol dysfunction). The outer third of the eyebrow thins out.
• The first symptom of hypothyroidism, which can appear up to five years before laboratory studies turn positive, is an unexplained, new-onset anxiety. ⁽³⁵⁾
• Severe Pain + Low Thyroid Output = Low T3 Syndrome/”Euthyroid Sick.” ⁽³⁶⁾
• Migraine headaches and hypothyroidism have a bidirectional association. ⁽³⁷⁾
• Arthralgias, myalgias, tenosynovitis, and carpal tunnel syndrome are presenting symptoms in patients with undiagnosed hypothyroidism. ⁽³⁸⁾
• Subclinical hypothyroidism can present as sensory neuropathy. ⁽³⁹⁾
  • Thyroid hormone replacement therapy can prompt nerve regeneration

• Oxytocin has direct analgesic effects ⁽⁴⁰⁾
  • Pain input stimulates a pulsatile impulse in the hypothalamus to induce the posterior pituitary gland to produce oxytocin. ⁽⁴¹⁾
    • Oxytocin activates endogenous endorphin production
      • Oxytocin binds to and activates CNS opioid receptors. ⁽⁴²⁾
        • Naloxone enhances oxytocin release.
      • Oxytocin is ineffective with opioids on board.
      • Oxytocin works best in an opioid-naive environment.
    • Oxytocin activates anatomic signal blockade.
      • Chronic pain input activates neuronal projections from the hypothalamus to the dorsal horn of the spinal cord receptors.
      • Oxytocin prevents pain signals from reaching the brain.
    • Oxytocin has beneficial effects on mood and depression. ⁽⁴³⁾
  • Oxytocin is short-acting, lasting only 4-6 hours. Use it best for short-term, non-opioid control of moderate to intermediate pain.
  • One can administer oxytocin with OTC products and ketamine.. ⁽⁴⁴⁾
  • Dose: 40-80 IU Sublingual Troche, Liquid, Nasal Spray

• Nandrolone is a 19-nortestosterone-synthetic anabolic steroid. Generally, we stay away from synthetic anabolic steroids, but in selected cases, including degenerative wasting, catabolic conditions, HIV, and Ehlers-Danlos Syndrome, nandrolone is an excellent aid. (45)
• Indications:
  • Degenerative, wasting, and catabolic disease states
  • Uses:
    • Anemia, osteoporosis, muscle tears, breast cancer, protein-wasting of old age, burns, and infections, particularly HIV.
• Severe, intractable pain states that progress to a catabolic state
  • Muscle wasting, anorexia, weakness, and weight loss.
  • Catabolic pain states occur with:
    • Metastatic carcinoma, HIV
    • Adhesive arachnoiditis, CRPS
    • Autoimmune disorders
• Ehlers-Danlos Syndrome ⁽⁴⁶⁾
  • Genetically induced hyperelasticity syndrome
    • Pathology revolves around progressive soft tissue degeneration.
      • Tissues involved include membranes, tiny nerve fibers, and spinal cord structures.
  • Severe, intractable pain syndromes develop with spontaneous organ rupture common.
  • Symptoms include:
    • Photophobia, nystagmus, vertigo, tinnitus, balance issues, muscle weakness, dysphagia, dysarthria, palpitations, IBS, syncope, and paresthesias of the fingers, toes, and lips.
  • Complications include:
    • Sleep disturbance, dysautonomia, hydrocephalus, arachnoiditis.
    • A catabolic state of existence
  • The Remedy (To reverse catabolism=Nandrolone) ⁽⁴⁷⁾
    • Indications-Weight loss, muscle wasting, anorexia, severe weakness (also used in HIV)
  • Dose-Trial for up to 2 months to test results
    • IM-50-100 mg 1/wk
    • Troche- 25-50 mg sL. 1-3 x/wk

• HGH/IGF-1 ^(48-49) aids in the regrowth of damaged tissue with improvements in pain relief, stamina, and energy. Signs and symptoms of deficiency include
  • Unexplained weight gain, decreased stamina
    • Labile mood, fatigue, decreased libido.
    • Loss of “Executive Function”
      • Memory
      • Task Initiation, Planning and Prioritizing, Organization
      • Flexible Thinking
      • Ability to Switch Between Tasks, Completing Tasks
  • Dose-0.35 mg/d subcutaneously in the abdomen.
• Vitamin D3-Low 25 OH Vitamin D results in non-specific musculoskeletal pain, headache, and fatigue ⁽⁵⁰⁾
  • Low vitamin D levels are a prominent feature of chronic pain syndromes.
  • Low vitamin D levels are related to geographic latitude and time of the year. The further from the equator and in the winter months equate to lower intrinsic levels of vitamin D. ⁽⁵¹⁾
  • Therapeutic Vitamin D levels are 50-80 nMol/L ⁽⁵²⁾
    • Exposing 50% of the skin for 12 minutes at mid-latitudes at noontime = 3.000 IU/d.
• Vitamin D3 is necessary for calcium absorption and bone strength. Vitamin D3 is required for adequate immune function, heart health, brain function, blood vessel integrity, insulin regulation, and mood stabilization.
• Dose: Every 1000 IU of a high-quality vitamin D3 increases the 25 OH vitamin D level by approximately 8 nMol/L
  • (Ex. 25 OH Vit D = 25 nMol/L; Supplement 5000 IU @ bedtime always
    • 5 x 8 = 40 nMol/L + 25 (Pt intrinsic Vit D) = 65 nMol/L Center of “Normal value of 30-100)

• Summary of Painful Phenomena in Terms of Hormonal Activity

Pain is a “stressor.” Severe pain stimulates the hypothalamus, pituitary, and adrenal glands to attempt a healing process.

Acute pain activates the hypothalamus to produce corticotropin-releasing, gonadal-releasing, and thyroid-releasing hormones. These hormones trigger the pituitary to produce pituitary-activated adrenal corticotropin (ACTH), pituitary-activated follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and pituitary-activated thyroid stimulating hormone (TSH).

ACTH prompts the adrenals to produce cortisol, pregnenolone, and DHEA. FSH and LH stimulate the gonads to produce testosterone, progesterone, and the three estrogens.

TSH regulates the generation of T3 and T4 in the bloodstream.

Unresolved severe pain leads to adrenal exhaustion with resultant lowered levels of cortisol and pregnenolone.

Daily opioid administration creates an opioid endocrinopathy” with diminution of testosterone and pregnenolone production.

The primary hormones involved in pain management we screen include:

1. Cortisol and ACTH
2. Testosterone
3. Pregnenolone
4. Progesterone
5. HCG
6. DHEA

Other hormones that play a lesser role in pain control but are of benefit in optimizing are:

1. Thyroid
2. Vitamin D
3. Prolactin
4. Oxytocin
5. IGF-1
6. Estradiol
7. Nandrolone

Laboratory Studies

You can measure hormone sufficiency using serum, urine, or saliva. Each method has pros and cons, and it is beyond the scope of this paper to discuss them. Every experienced hormone optimization specialist has developed a system that works for them. Here is our protocol for utilizing serum testing.

• CBC, CMP, Lipid Profile, Homocysteine

–RBC Magnesium, RBC Zinc, RBC Selenium

• Hormones (Days 19-21 of the cycle if pt is menstruating)

Testosterone, free, Total, SHBG, DHEA Estradiol, Estrone, Progesterone

IGF-1, Insulin, Cortisol AM and PM

Thyroid-TSH, fT3, fT4, TPO, Antithyroglobulin, Reverse T3 Pituitary Hormones-ACTH, GH, LH, FSH, (TSH), Oxytocin, “Minor Hormones”-Pregnenolone, Prolactin, Melatonin

• Inflammatory Markers

cRP, 25 OH Vitamin D, Homocysteine

• RBC Markers

Ferritin, B-12, Folic Acid

Conclusion

Managing chronic pain presents a complex and often frustrating challenge. Optimizing hormones rarely appears on the radar of pain management specialists, yet effective pain relief demands a comprehensive understanding of how hormonal imbalances exacerbate pain syndromes. Our research highlights the necessity of addressing the ‘endocrinology of pain management’ to restore functionality and enhance the quality of these patients’ lives.

For individuals grappling with chronic pain, assessing and managing hormones opens new avenues for collaboration with healthcare providers. A well-designed, personalized, holistic treatment plan must incorporate this essential tool.

In the case of our struggling plastic surgery resident, good ultimately triumphed over adversity at his most challenging moment. By embracing the principles of this “new” medicine, he overcame the obstacles impeding his daily life. After many trials and setbacks, he found professionals willing to challenge conventional practices—grounded in evidence-based literature—ultimately salvaging his career and revitalizing his life.

Empowered by his newfound insights, Doctor Plastic Surgery became a functional medicine provider. Sharing his experiences and vision with countless individuals seeking similar improvements, his journey exemplifies the profound benefits of an integrative, holistic approach to healing.

His transformation serves as a powerful testament to the potential for healing and, in this instance, emphasizes the critical role of hormone health in achieving a vibrant and fulfilling life. Your functional, alternative, anti-aging medical provider has many other tips and tricks to help you get the most out of your life.

xxxx

A Concise Summary of Hormonal Functions and Deficiency Symptoms

References

1. Tennant F. Hormone abnormalities in severe chronic pain patients who fail standard treatment. Postgrad Med. 2015;127(1):1-4.
2. Abs R, Verhelst J, Maeysaert J, et al. Endocrine consequences of long term intrathecal administration of opioids. J Clin Endocrinol Metab. 2000;85:2215–2222. doi: 10.1210/jc.85.6.2215
3. Bennett RM, Clark SR, Burkhardt CS,et al. A randomized double-blind placebo-controlled study of growth hormone in the treatment of fibromyalgia. Amer J of Med. 1998.104: 227-231.
4. Tennant F. Hormone testing and treatment enters pain care. Hosp Pract (1995). 2014 Dec;42(5):7-13. doi: 10.3810/hp.2014.12.1154. PMID: 25485913.
5. Tennant F. Hormone Testing and Replacement in Pain Patients Made Simple. Pract Pain Manag. 2012;12(6).
6. Baulieu, EE., Schumacher, R.,” Neurosteroids: Beginning of the Story,” Int. Review of Neurobiology, Paris, France; 2003;46:1
7. Schverer M, Lanfumey L, Baulieu EE, et al. Neurosteroids: non-genomic pathways in neuroplasticity and involvement in neurological diseases. Pharmacol Ther. 2018; 191:190-206.
8. García-Estrada J, Luquín S, Fernández AM, Garcia-Segura LM. Dehydroepiandrosterone, pregnenolone, and sex steroids down-regulate reactive astroglia in the male rat brain after a penetrating brain injury. Int J Dev Neurosci. 1999;17(2):145-151.
9. 10. Djebaili M, Guo Q, Pettus EH, et al. The neurosteroids progesterone and allopregnanolone reduce cell death, gliosis, and functional deficits after traumatic brain injury in rate. J Neurotrauma. 2005;22(1):106-118. Bastianetto S, Rama
10. 11. Jones KJ. Gonadal steroids and neuronal regeneration: a therapeutic role. Adv Neurol. 1993;59:227-240.
11. Tennant F, Herman L. Normalization of serum cortisol concentration with opioid treatment of severe chronic pain. Pain Med. 2002;3:132-134.
12. https://www.urologyhealth.org/urology-a-z/l/low-testosterone#Symptoms
13. Adams ML, Sewing B, Forman JB, Meyer ER, Cicero TJ. Opioid-induced suppression of rat testicular function. J Pharmacol Exp Ther 1993;266:323-8.
14. 29. Vuong C, Van Uum SH, O’Dell LE, Lutfy K, Friedman TC. The effects of opioids and opioid analogs on animal and human endocrine systems. Endocr Rev 2010;31:98-132.
15. 30. Daniell HW. Hypogonadism in men consuming sustained-action oral opioids. J Pain 2002;3:377-84.
16. 31. Mendelson JH EJ, Judson B, Goldstein A. Plasma testosterone and luteinizing hormone levels during levo-alpha-acetylmethadol maintenance and withdrawal. Clin Pharmacol Ther 1984;35:545-7.
17. 32. Abs R, Verhelst J, Maeyaert J, Van Buyten JP, Opsomer F, Adriaensen H, et al. Endocrine consequences of long-term intrathecal administration of opioids. J Clin Endocrinol Metab 2000;85:2215-22
18. 33. Daniell HW. Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. J Pain 2008;9:28-36
19. Wang M. Neurosteroids and GABA-A Receptor Function. Front Endocrinol (Lausanne). 2011 Oct 4;2:44. doi: 10.3389/fendo.2011.00044. PMID: 22654809; PMCID: PMC3356040.
20. Tai, P., 8 Powerful Secrets to Anti-Aging, Health Secrets USA, Tucker, GA; 2007:89.
21. Baulieu E. E., Robel P., Schumacher M. (2007). Neurosteroids: the beginning of the story. Int. Rev. Neurobiol. 46, 1–32
22. Kitts JD, Tupler LA, Keefe FJ, et al. Neurosteroids and self-reported pain in veterans who served in the US military after September 11, 2001. Pain Med. 2010;11:1469-1476.
23. J. Strömberg, D. Haage, M. Taube, T. Bäckström, P. Lundgren, Neurosteroid modulation of allopregnanolone and GABA effect on the GABA-A receptor, Neuroscience,Volume 143, Issue 1, 2006,Pages 73-81,ISSN 0306-4522, https://doi.org/10.1016/j.neuroscience.2006.07.031.
24. Tai, P., 8 Powerful Secrets to Anti-Aging; United Writers Press inc., Tucker, Ga, 2007;144.
25. Matura S, Okashi M, Chan HC, et al. Physiochemical and immunological characterization of an HCG-like substance from human pituitary glands. Nature. 1980;286:740-741.
26. Tennant F. Human Chorionic Gonadotropin in Pain Treatment. Pract Pain Manag. 2009;9(5).Odell WD, Friffin J. Pulsatile secretion of human chorionic gonadotropin in normal adults. N Engl J Med. 1987;817;1688-1692
27. Odell WD, Friffin J. Pulsatile secretion of human chorionic gonadotropin in normal adults. N Engl J Med. 1987;817;1688-1692
28. Baulieu EE, Robel P. Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) as neuroactive neurosteroids. Proc Natl Acad Sci USA. 1998;95(8):4089-4091.
29. Chang DM, Chu SJ, Chen HC, Kuo Sy, Lai JH. Dehydroepiandrosterone suppresses interleukin 10 synthesis in women with systemic lupus erythematosus. Ann Rheum Dis. 2004;63(12):1623-1626.
30. Karishma KK, Herbert J. Dehydroepiandrosterone (DHEA) stimulates neurogenesis in the hippocampus of the rat, promotes survival of newly formed neurons and prevents corticosterone-induced suppression Eur J Neurosci. 2002;16(3):445-453.
31. Tennant F. Hormone abnormalities in severe, chronic pain patients who fail standard treatments. Postgrad Med. 2015;127(1):1-4.
32. Tai, P., 8 Powerful Secrets to Anti-Aging; United Writers Press inc., Tucker, Ga, 2007;79.
33. Dons RF, Shaki KMM. Changes in triiodothyronine mark severe pain syndrome: a case report. Military Med 1994; 159:465-6.
34. Glynn CJ and Lloyd JW. Biochemical changes associated with intractable pain. Br Med J. 1978. 1:280-1.
35. Chaker, L., Razvi, S., Bensenor, I.M. et al. Hypothyroidism. Nat Rev Dis Primers 8, 30 (2022). https://doi.org/10.1038/s41572-022-00357-7
36. Dons RF and Shaki KMM. Changes in triiodothyronine mark severe pain syndrome: a case report. Military Med. 1994. 159:465-6.
37. Rainero I, Govone F, Gai A, et al. Is migraine primarily a metabolic endocrine disorder? Curr Pain Headache Rep. 2018;22(5):36. doi:10.1007/s11916-018-0691
38. Atcheson SG, Ward JR, Lowe W. Concurrent medical disease in work-related carpal tunnel syndrome. Arch Intern Med. 1998;158:1506.
39. Penza P, Lombardi R, Camozzi F, Ciano C, Lauria G. Painful neuropathy in subclinical hypothyroidism: clinical and neuropathological recovery after hormone replacement therapy. Neurol Sci. 2009 Apr;30(2):149-51. doi: 10.1007/s10072-009-0026-x. Epub 2009 Feb 13. PMID: 19214379.
40. Paloyells Y, Krahe C, Mahazos S, et al. The analgesic effect of oxytocin in humans: a double-blind, placebo-controlled crossover study using laser-evoked potentials. J Neuroendocrinol. 2016;28(4):
41. Rash JA, Aguirre-Camacho A, Campbell TS. Oxytocin and pain: a systematic review and synthesis of findings. Clin J Pain. 2014;30(5):453-462.
42. Leng G, Dyball RE, Way SA. Naloxone potentiates the release of oxytocin induced by systemic administration of cholecystokinin without enhancing the electrical activity of supraoptic oxytocin neurones. Exp Brain Res. 1992;88(2):321-5. doi: 10.1007/BF02259107. PMID: 1577106.
43. Paloyells Y, Krahe C, Mahazos S, et al. The analgesic effect of oxytocin in humans: a double-blind, placebo-controlled crossover study using laser-evoked potentials. J Neuroendocrinol. 2016;28(4)
44. Tennant F, Pedersen C. Sublingual Oxytocin and Ketamine for Pain Relief. Presented at PainWeek. September 5-9, 2017, in Las Vegas, Nevada.
45. Sattler FR, Jaque SV, Schroeder ET, et al. Effects of pharmacological doses of nandrolone decanoate and progressive resistance training in immunodeficient patients infected with human immunodeficiency virus. J Clin Endocrinol Metab. 1999;84(4):1268-1276.
46. Savasta S, Merli P, Ruggieri M, et al. Ehlers-Danlos syndrome and neurologic features: a review. Childs Nerv Syst. 2011; 27(3):365-371.
47. Gold J, High HA, Li Y, et al. Safety and efficacy of nandrolone decanoate for treatment of wasting in patients with HIV infection. AIDS. 1996;10(7):745-752.
48. Tennant F. Hormone Treatments in Chronic and Intractable Pain. Pract Pain Manag. 2005;5(3).
49. Wolfe F et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Arthritis Rheum. 1990. 33: 160-172.
50. Knutsen KV, Brekke M, Gjelstad S, Lagerlov P. Vitamin D status in patients with musculoskeletal pain, fatigue and headache: A cross-sectional descriptive study in a multi-ethnic general practice in Norway. Scand J Prim Health Care. 2010;28:166–71.
51. Straube S, Andrew Moore R, Derry S, McQuay HJ. Vitamin D and chronic pain. Pain. 2009;141:10–1
52. Heaney RP. The Vitamin D requirement in health and disease. J Steroid Biochem Mol Biol. 2005;97:13–19.

Video Presentation on YouTube

Dr. William Clearfield

Website | + posts

This author does not have any more posts.