Why Does My Pain Therapy Make Me Feel So Lousy?

David J. Miller, RPh,

David J. Miller, RPh, PhD, FIACP, FACA

NERD WARNING: The first two paragraphs get a little technical so hang in there.

When morphine or another opioid (narcotic) is given to a person, it acts on an area of the brain called the hypothalamus to inhibit the release of many hormones. Opioids act in the hypothalamus to inhibit the release of gonadotropin releasing hormone thus decreasing the release of follicle stimulating hormone (FSH) and Leutinizing Hormone (LH). FSH and LH work synergistically to cause the Lydig cells in the testes to produce testosterone in men and in women, estrogen production in the ovaries.

In addition, when the body is stressed either emotionally or physically, it produces a hormone called cortisol to help quell the inflammation that the stress creates. The precursor hormones for cortisol production are the same as the sex hormones including testosterone, estrogen, and progesterone. If the body “steals” the precursors to make cortisol, it can essentially starve the body of the building blocks for the hormones.

What does all of this mean for a pain patient? It is highly probably that hormonal imbalance is contributing to your pain, fatigue and lack of sense of well being. Analysis of nearly 2800 patients demonstrated that the average testosterone level in men using opioids was 165ng/dl lower than in men not using opioids . This is a huge difference. It could mean the difference between having a “normal” level and severely “low” level. Another study looked at testosterone replacement in men with opioid induced testosterone deficiency . This study found that testosterone administration improvements in pain, sexual desire, body composition, and aspects of quality of life.

If you, or someone you love suffers from pain and use opioids to control the pain, hormone balance is worth discussing with your doctor. I recommend saliva testing or blood testing for testosterone (total and free), estradiol, progesterone and cortisol. If any of these hormones are out of range, a myriad of hormone replacement options exist to help correct imbalances. Keystone Pharmacy’s experts can help your doctor establish appropriate therapies that could have a significantly positive impact on your quality of life.

As an aside, Keystone Pharmacy is rolling out its FIVE STAR suite of consulting services. This suite of services includes anti-aging and hormone balance, nutrition, peripheral neuropathic pain, medication therapy management and pharmacogenitic counseling, skin care and veterinary medication administration advice. We are excited to be launching this suite of service and look forward to serving you.

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