Thursday, April 14, 2011

Chorionic Gonadotropin Soothes Intractable Pain?

Human chorionic gonadotropin (hCG), a drug frequently used in fertility therapy, relieved intractable pain for most patients in a small pilot study, according to a recent conference report. However, while hCG might be a viable adjunct to the limited other treatments for intractable pain, more and better research is needed to confirm this.

At the recent annual meeting of the American Academy of Pain Medicine, Forest Tennant, MD, DrPH — of the Veract Intractable Pain Clinic, West Covina, California — described initially administering hCG in challenge dosages of 500 to 1,000 units to 12 patients to determine an effective dosage regimen and possible adverse reactions [Tennant 2011]. All patients were ambulatory adults who had experienced intractable pain for at least 5 years and required opioids for pain management.

Seven patients had spine conditions and the others had fibromyalgia, neuropathy, arthropathy, or headache. They also had presumed abnormal central neuroplasticity based on several criteria: consistent pain at peripheral pain sites that failed to respond to therapy; severe insomnia; and severe hyperactivity evidenced by 2 or more conditions, such as hypertension, tachycardia, tremor, hyperactive reflexes, mydriasis, diaphoresis, or cold hands or feet.

Two thirds of the patients (8) experienced positive effects from their challenge dosage within one week and continued hCG therapy for more than 52 weeks at a dose of 1,000 to 3,000 units/week. All of these patients reported positive effects, including: increased energy, improved mental concentration and memory, less depression, fewer pain flares and more pain-free hours. Seven of the 8 (87.5%) reduced their opioid use by 30 to 50%. No adverse effects of hCG therapy were observed.

COMMENTS & CAVEATS: Tennant concluded that the observed symptom improvement suggests that hCG may correct some of the adverse neuroplasticity associated with severe intractable pain and larger scale clinical trials seem justified. At present, however, the findings represent a small case series, published as an abstract, and there were many potential sources of bias that might have influenced outcomes.

Normally, we would not report on a preliminary study such as this, but there are relatively few therapies with demonstrated effectiveness for intractable pain and hCG may offer a novel new option. In a related news story [Susman 2011], Tennant concedes he was skeptical at first: “We got involved with hCG when colleagues at a weight loss clinic told us that obese fibromyalgia patients treated with hCG were experiencing great pain relief.”

“It is unclear whether hCG acts as a hormonal stimulant and/or an anabolic, connective tissue agent,” Tennant said. In his abstract, he notes that hCG is comprised of two amino acid subunits that provide a theoretical basis for use in pain treatment. One unit contains follicle stimulating hormone (FSH), luteinizing hormone (LH), and thyroid stimulating hormone (TSH). The other unit is an androgenic compound that increases cyclic adenosine monophosphate (cAMP) and nitric oxide (NO).

Most commonly, hCG is used for in vitro fertilization procedures and in some weight loss programs; however, because of its past use in conjunction with anabolic steroids the agent is barred by some professional sports organizations and might be viewed suspiciously by pain practitioners. According to Tennant, “Because we have seen responses, we have begun extending the treatment to other patients…. [and] have treated 30 to 40 people with intractable pain with hCG.”

REFERENCE: Tennant FS. Human Chorionic Gonadotropin in Intractable Pain. Presented at the Annual Meeting of the American Academy of Pain Medicine; Washington, DC, March 2011. Poster 164 [available here].
ALSO SEE further information at…
> Susman E. AAPM: Hormone Tx May Relieve Intractable Pain. MedPage Today. March 25, 2011 [
available here].
> Tennant F. Human Chorionic Gonadotropin in Pain Treatment. Practical Pain Management. 2009(Jun) [
available here].