The Endocrinology of Pain Management with Dr. Bill Clearfield

Severe, persistent pain is a stressor on your patient’s homeostatic system. Pain depresses hormonal response. Adequate pain control with opioids also depresses hormonal function. If the patient’s hormones are not balanced, the patient cannot function at an optimal level and deteriorates.

When pain flares, excess cortisol leads to LH suppression, testosterone deficiency, fatigue, and “burnout.” Our goal is to balance the hormones depleted, leading to a harmonious hormonal symphony.

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The major adrenal and gonadal hormones become deficient during pain crises and ongoing opioid treatment. These patients do not respond well to prescribed pain medication and report symptoms such as poor pain control, depression, mental impairment, insomnia, allodynia, and hyperalgesia. Pain practitioners must thoroughly understand the combined effect of pain and opioid-induced suppression on the hormonal system.

An added benefit of hormone harmony is due to the anabolic and regenerative properties certain hormones possess. Dr. C discusses the hormones involved and which patients will benefit most from a hormone evaluation.

Lastly, we look at biomarkers we can use to navigate the world of hormones safely and the inflammatory proteins (cytokines) affected by each hormone.