Cortisol Levels and Chronic Pain
According to a new study conducted by Dr. Forest Tennant, from Veract Intractable Pain clinic, West Covina, California, patients with severe chronic pain tend to have low serum cortisol levels. He found patients with arachnoiditis have even lower serum cortisol levels. Arachnoiditis describes a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord.
The study included 90 subjects with chronic intractable pain, which was defined as a constant, severe, disabling pain causing changes in pulse rate, blood pressure and adrenal hormone production. The study also included 26 subjects with arachnoiditis and 86 subjects without a pain condition. Blood samples were collected from all subjects and a computer program was used to convert the samples to be equivalent to noon time, as cortisol levels are higher in the morning. Patients with arachnoiditis had a mean cortisol level of 6.52 mcg/dL while patients without pain had a mean cortisol level of 12.58 mcg/dL and patients with chronic pain had a mean cortisol level of 10.72 mcg/dL.
While arachnoiditis and chronic pain are often treated with opioids, these medications can lower cortisol levels even further. Dr. Tennant proposed that a preferable approach would be to prescribe cortisol supplements which helps patients who don’t have enough of their own cortisol to heal or make their pain medications work.
Dr. Robert Bonakdar, director of pain management, Scripps Center for Integrative Medicine, La Jolla, California agrees, stating: “We know that acute pain causes a stress response, and as pain becomes chronic, many patients will exhaust this important response. This depletion can help explain the fatigue, mood changes, and other non-pain comorbidities our chronic pain patients often exhibit.”
Dr. Tennant reports he has reduced his opioid prescribing to these patients by 50% in the past 2-3 years by prescribing cortisol supplements.
Given the opioid crisis in our nation, it may be worth ordering a simple lab to check cortisol levels in patients with severe chronic pain prior to initiating opioids.
Intractable Pain Linked to Low Cortisol. Medscape Medical News. Oct 03, 2016. Coverage of American Academy of Pain Management (AAPM) 2016 Annual Meeting: Poster 5. Presented September 23, 2016.
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