March 28, 2011 (Washington, DC) — Results from a small study of obese patients with intractable pain showed that treatment with human chorionic gonadotropin (HCG) was associated with a significant reduction in symptoms.
The findings were presented here, in a highlighted poster session, at the 27th annual meeting of the American Academy of Pain Medicine.
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| Dr. Forrest Tennant |
The author of the study, Forrest Tennant, MD, from the Veract Intractable Pain Clinic in West Covina, California, told Medscape Medical News in an interview that he was contacted by a weight loss clinic about a year and a half ago and told that patients with intractable pain treated at the clinic with HCG had reported significant reductions in several indices of pain.
"Patients with painful fibromyalgia and arthritic conditions were getting significant relief from their pain when prescribed HCG," he said. In-person interviews with the patients confirmed the positive effects of the treatment.
Twelve patients were studied. They were all ambulatory adults who had experienced intractable pain for at least 5 years, Dr. Tennant said, and all of the patients had presumed neuroplasticity on the basis of several clinical characteristics, including constant pain, peripheral pain sites that responded poorly or did not respond at all to local treatments, severe insomnia, and sympathetic hyperactivity as evidenced by 2 or more of the following:
Hypertension;
Tachycardia;
Tremor;
Hyperactive reflexes;
Mydriasis;
Diaphoresis; and
Cold hands and/or feet.
"More than half of the patients had spinal conditions and the rest had fibromyalgia neuropathy, arthropathy, or severe headaches," Dr. Tennant said.
All the patients had been taking a long-acting opioid plus short-acting opioids for breakthrough pain. Their morphine equivalences ranged from 500 to 1500 mg/day. "These were not run-of-the-mill patients," Dr. Tennant said. "These were 'the severe of the severe,' what we would term very intractable patients with presumed central abnormal neural plasticity."
Dr. Tennant gave the patients a challenge dose of 500 to 1000 units of HCG subcutaneously, and 8 of the 12 patients reported feeling improvement in pain symptoms over the course of the next week, he said. For the next year, those 8 patients continued to receive HCG, 1 to 3 injections per week. Weekly subcutaneous dosages were 1000 to 3000 units per week. No other changes were made in the patients' therapy, Dr. Tennant said.
Reduced Opioids
After a year of the therapy, no side effects were seen in the 8 patients. All reported increased energy and mental concentration, less depression, and fewer flares of severe pain. Seven of the 8 patients cut down on their use of opioids by 30% to 50%, Dr. Tennant said, and 5 of the patients reported having experienced at least some pain-free hours. All 8 patients expressed desire to continue treatment with HCG.
Dr. Tennant conceded that the study is small and that open-label studies such as this one are inherently biased and nonrandom. Still, he said, "I've been specializing in treating pain for the past several decades, and the improvements I've seen in these patients have been impressive."
He added, "It's been my experience that severe intractable pain patients with presumed abnormal neuroplasticity — who are being maintained on opioids — seldom report improvement with any nonopioid therapy."
It's been my experience that severe intractable pain patients with presumed abnormal neuroplasticity — who are being maintained on opioids — seldom report improvement with any nonopioid therapy.
In addition, achieving pain-free hours, coupled with reduced opioid usage, isn't a common occurrence, he said.
As to the mechanism for the reported reduction in pain, Dr. Tennant said it's not clear whether HCG functions as a hormonal stimulant or an anabolic, corrective tissue agent.
"We know that opioids suppress endocrine function, so it may be that HCG is neutralizing that complication by stimulating gonadal and thyroid production. In turn, that may allow intrinsic correction of abnormal neuroplasticity," he said. Also, it may be that HCG has a direct tissue anabolic effect that provides healing and normal cellular function of abnormal neuron and glial cells, he said.
Independent Effect?
Commenting on the presentation, Dr. Mark Bailey, director of the Department of Neurology Pain Management at the University of Alabama, Birmingham, said, "This is an interesting study. I know that HCG is used in some weight reduction clinics, but I don't know of any other instances where people have been on that hormone for as long as a year, so that's unusual," he said.
Dr. Bailey did say he wondered how much weight loss had to do with patients’ reductions in pain. "That would be sort of independent of these mechanisms that are postulated here. It wouldn't surprise me, particularly with this population of obese patients with painful fibromyalgia and arthritic conditions, that if you had those patients lose a significant amount of weight, they would experience less pain, regardless of any other factors," he said.
Even so, he added, "It's an interesting line of research, and I plan on keeping an eye on it."
Dr. Tennant said he's confident that HCG therapy for intractable pain is a fruitful area of inquiry and he plans to pursue it. "We've now put another 30 to 40 intractable pain patients on this hormone and we're getting positive results in 85% to 90% of them," he said.
He said he plans to publish results on a larger cohort of patients this fall.
Dr. Tennant has disclosed no relevant financial relationships.
27th Annual Meeting of the American Academy of Pain Medicine (AAPM); Washington, DC; Poster #164. Presented March 24, 2011.
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