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Opioid Pain Medication and My Beleaguered Hormonal System

  [ 9 votes ]   [ 2 Comments ]
By Tamara Staples • www.ProHealth.com • September 12, 2012


Pain information tracker Tamara Staples lives with arthritis, fibromyalgia and lupus, and shares what she learns via her website, PainNinja.com & free Conquering Pain e-newsletter. This article, first published March 30, 2012, is reproduced with her kind permission. ©Tamara Staples 2012. All Rights Reserved.

___________________

Opioid Pain Medication and My Beleaguered Hormonal System

Tamara Staples (Pain Ninja)

A couple of years ago my fibromyalgia had become quite bad and so I made an appointment with a pain management specialist at OHSU (Oregon Health & Science University, Portland).

As I always do, I took my recent lab results with me to the appointment. Among these were findings that showed my hormones were totally out of whack.

I had recently found out that my DHEA was all but non-existent, my testosterone levels were extremely low, my estrogen and progesterone were both low as was my nighttime cortisol.

The doctor said, matter of factly, “Oh yes, we see this all the time. Opioid pain medication disrupts the body’s hormonal system.”

Really?

At this point I had been on opiate pain medication daily for over a decade. However, this all kind of washed over my head because I was thinking of getting off the opiates and trying low-dose Naltrexone (LDN), which I had just heard about from this video featuring Dr. Sean Mackey from Stanford University.*

And, I did. For a number of months, I was off opiate pain medication and treating my fibro with LDN and more natural methods…and then I slipped back into taking pain medication again. I am not totally sure why. Partly it was just easier than managing the pain by other methods. At the time, I forgot all about it - unbalancing my hormones. 

Of course, if you read this post (“What I Didn’t Know About Pain Pills ‘Could’ Hurt Me!”), you will know that I am now off the opiates again for good and that I am wishing I had never gone back on them. Ah, hindsight!

Here are the facts about opiate pain medication and hormones…

The hormonal effects of opioid usage affect both men and women and have been documented during oral consumption as well as transdermal, intravenous and intrathecal administration. Various studies have shown the opioid usage affects a variety of hormones including testosterone, estrogen, DHEA, cortisol and others.

Men can suffer from side effects including sexual dysfunction (i.e., erectile dysfunction, decreased libido, etc.), depression and decreased energy levels. While women experience depression, dysmenorrhea, sexual dysfunction and potentially, reduced bone mineral density.

In women, the reduction in estrogen may lead to osteoporosis and fractures in the older population.

One source indicated that long-term opioid use could cause sex hormone production to nearly stop with the entire hormonal system impacted, including the thyroid. The consequences can create a domino effect that can cause emotional imbalances, sleep disruption, metabolic changes and cardiovascular stress.

In addition, opioid drugs may affect the immune system. Preclinical research has shown that opioids alter the development, differentiation and function of immune cells.

I am now working with my naturopath to balance my thyroid, adrenals and sex hormones. I have no idea, and could not tell from my research, if the damage to the endocrine system is permanent or able to be repaired once the opioids are stopped. I guess time will tell.

[Ed note: a report published in the July, 2012 issue of Pain Physician does suggest therapy options if needed. See
“Important opioid-induced deficiency linked to hot flashes, fatigue, weight gain, depression, more.”]

I do know that I am no longer willing to jeopardize major body systems by taking opioid pain medications on a regular basis. I will reserve their use for emergency short-term use only.

___

* This video is about 3 years old at this point. There is even more data out recently confirming that LDN is beneficial in treating fibromyalgia.

Resources:

“Opioid Complications and Side Effects” (Pain Physician, 2008)
http://www.painphysicianjournal.com/2008/april/2008;11;S105-S120.pdf

“Opioids for Chronic Nonterminal Pain” (Southern Medical Journal, 2006)
http://www.medscape.com/viewarticle/549294

“The Consequences of Long-Term Opioid Use for Chronic Pain” (HealthCentral, May 23, 2011)
http://www.healthcentral.com/chronic-pain/c/27148/138734/consequences

“The Effects of Opioids and Opioid Analogs on Animal and Human Endocrine Systems” (Endocrine Reviews, 2010)
http://edrv.endojournals.org/content/31/1/98.full.pdf

Note: this information has not been reviewed by the FDA. It is general and anecdotal, based on the research and opinions of the author, and is not meant to prevent, diagnose treat or cure any illness, condition or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.



Please Discuss This Article:   Post a Comment 

thank you
Posted by: uselesswithfm
Sep 16, 2012
Hello Tamara,
I know your name from the fibromyalgia support group that you run that I can never get to, but follow quite frequently. I was surprised to come across your name here in these message boards. I was unaware of the hormonal imbalances being caused by opioid pain medication. I too have been a long term patient with fibromyalgia and even recently had an appointment with my rheumatologist where she refilled my rx, with no problems, but maybe a bi-yearly visit, not understanding why no primary care provider I can find will write an rx. They outright refuse "our clinic has a policy"... But they don't tell you that until after you have unloaded on them why you need it in the first place. Not one doctor has ever said "opioids affect your hormones, so these symptoms you are having my be caused by the medicine you are taking. Lets run some labs and check some levels to see what's going on?
Thank you for taking the time to post since I know that your life is very busy not just managing your daily life but taking the time to run a support group. I just wish I could make it to one of the meetings. I absolutely love it when you are able to video tape, or have a webcast.
Please take care and a big "Way To Go" for being able to "deal" with daily pain and for finding a way to give back to those of us who struggle with just being able to "deal."
One day I hope to meet you and feel like I have known you like an old friend. Sincerely, Debbie H.
Reply Reply

 
Thank you, Debbie!
Posted by: PainNinjaTamara
Sep 17, 2012
I am so glad you found the article helpful. I am wondering how many doctors actually know all of the "hidden" dangers of daily opioid therapy. As I mentioned in the article, my pain management doctor told me in an offhand kind of way about the opioids disrupting my hormonal balance, but then she went on to write me pain scripts and I really didn't take it all that seriously. However, I finally HAD to stop opioids because of gastroparesis they were causing and adrenal insufficiency secondary to opioid therapy.

I can honestly say that I feel so much better without them -- once I made it through the withdrawal period. My pain levels came down and down and down. Things that used to seriously hurt such as acupuncture or having blood drawn or even stubbing my toe, now cause very little pain at all. So, in addition to the hormonal, digestive and adrenal issues, I was also experiencing opioid induced hyperalgesia. Meaning that they were creating more pain than they were relieving.

Today, using meditation, EFT, visualization, stretching, breathing exercises, etc., I have almost no pain. I have to behave and pace myself or I will be in a flare and in pain, but as long as I am caring for myself properly, my pain levels are very, very low.

I am currently working on another article about the full range of problems associated with daily opioid therapy. It will be posted on my blog in a week or so. I am not opposed to opioids for those that really need them. I do; however, want every patient to be able to make an informed decision about their use. :)

 

 
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