The Physiologic Effects of Pain on the Endocrine System

Tennant, Forest S.

doi:10.1007/s40122-013-0015-x

Cited by 97 publications

(66 citation statements)

References 65 publications

(77 reference statements)

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“…These findings support studies that show that severe and constant pain has a 2-phase effect on the endocrine system [2,[4][5][6]9,10]. Initially, severe pain stimulates the hypothalamus, pituitary, adrenal, and gonad (HPAG) axis to hypersecrete hormones into the serum as a protective or immunologic measure to eliminate an injurious painful assault.…”

Section: Discussionsupporting

confidence: 85%

“…This finding may reflect the different physiologic effects of severe pain and opioids on the releasing hormones in the hypothalamus and pituitary. There may also have been a pain-concomitant stimulatory and suppressive effect [2].…”

Section: Discussionmentioning

confidence: 99%

“…Although severe, chronic pain is known to have profound effects on endocrine function, no studies have systematically attempted to identify hormone abnormalities in patients who have uncontrolled pain and who have not responded to standard treatments [2][3][4][5][6][7]. A goal of this study was to determine if hormone abnormalities might serve as biomarkers for uncontrolled pain and provide the practitioner with objective evidence that enhanced analgesia is required.…”

Section: Introductionmentioning

confidence: 99%

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Hormone abnormalities in patients with severe and chronic pain who fail standard treatments

Tennant¹

2014

Postgraduate Medicine

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Some patients with severe and chronic pain fail to obtain adequate pain relief with standard pharmacologic treatment agents, including low to moderate dosages of opioids. Understandably, physicians might not believe patients who claim that a standard opioid dosage is an ineffective treatment. These patients may be severely impaired, nonfunctional, and bedridden or housebound. To help characterize these individuals and develop treatment strategies for them, a serum hormone profile consisting of adrenocorticotropin, cortisol, pregnenolone, progesterone, dehydroepiandrosterone, and testosterone was obtained on 61 chronic pain patients who failed standard treatments; 49 patients (80.3%) demonstrated ≥ 1 hormone abnormality defined as a serum concentration or level above or below the normal range, and 7 patients (11.5%) showed a severe pituitary-adrenal-gonadal deficiency as indicated by deficient serum levels of adrenocorticotropin and ≥ 2 adrenal-gonadal hormones. Hormone serum abnormalities are biomarkers of severe, uncontrolled pain, and, in a patient who has failed standard treatment, they are an indicator that enhanced analgesia is required and that hormone replacement may be indicated.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hormone abnormalities in patients with severe and chronic pain who fail standard treatments

Tennant¹

2014

Postgraduate Medicine

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“…The link between pain (acute or chronic), function of the hypothalamic–pituitary–adrenal (HPA) axis and the subsequent effect on cortisol levels has been well-documented in the literature 1 . Cortisol has important regulatory functions including glucose production, maintenance of the central nervous system, and anti-inflammatory properties that limit the spread of pain 1 .…”

Section: Introductionmentioning

confidence: 99%

Exploring the relationship between disease-related pain and cortisol levels in women with osteoarthritis

Carlesso

Sturgeon

Zautra

2016

Osteoarthritis and Cartilage

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Objectives To determine if 1) Osteoarthritis (OA)-related pain is associated with the diurnal cortisol pattern and cortisol levels; 2) the diurnal pattern of cortisol varies with severity of OA pain and 3) the association between OA pain and cortisol is mediated by daily experience variables (DEV). Design In a community-based study of changes in regional and widespread pain among women with OA, participants (n=31) completed daily diaries and collected three saliva samples daily for 7 days. Severity of OA-related pain was assessed by the validated Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Multilevel regression analyses estimated associations between OA pain and diurnal cortisol levels and slopes, controlling for body mass index, medication use, time and day. Mediation analyses examined DEV as potential mediators of the association between OA pain and cortisol. Results The mean age was 57 years and average BMI 31kg/m2. Mean WOMAC pain subscale score was 8.8. Women with higher WOMAC pain scores had higher cortisol throughout the day. The estimated association of WOMAC with cortisol [ß 0.083(0.02, 0.15) p =0.009] represents a ~ 9% increase in cortisol for every unit increase in WOMAC pain score. Women with WOMAC pain scores ≥ 9 had higher cortisol levels than those with scores <9. Examination of DEV revealed no significant mediated associations between these relationships at the daily level. Conclusion In women with OA, disease-related pain is positively associated with cortisol production, particularly with greater pain severity. Future studies should explore biologic mediating variables between OA pain and cortisol.

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“…The dynamic nature of care in such units may create barriers for patients to request support. This behavior fails to consider the potential limitations imposed by pain, which include increased rates of secondary complications, prolonged hospital stay, neurovegetative changes, and risk of chronification (9,(13)(14) . In most of the cases, pain characteristics were not recorded; thus, we infer that attempts were rarely made to collect this information.…”

mentioning

confidence: 99%

Pain assessment and management in patients undergoing endovascular procedures in the catheterization laboratory

Hilário

Santos

Krüger

et al. 2017

Rev. esc. enferm. USP

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Objective:To describe how pain is assessed (characteristic, location, and intensity) and managed in clinical practice in patients undergoing endovascular procedures in the catheterization laboratory setting. Method: Cross-sectional study with retrospective data collection. Results: Overall, 345 patients were included; 116 (34%) experienced postprocedural pain; in 107 (92%), pain characteristics were not recorded; the location of pain was reported in 100% of patients, and its intensity in 111 (96%); management was largely pharmacologic; of the patients who received some type of management (n=71), 42 (59%) underwent reassessment of pain. Conclusion: The location and intensity of pain are well reported in clinical practice. Pharmacologic pain management is still prevalent. Additional efforts are needed to ensure recording of the characteristics of pain and its reassessment after interventions. DESCRIPTORSPain; Acute Pain; Pain Management; Endovascular Procedures; Nursing Care. Pain assessment and management in patients undergoing endovascular procedures in the catheterization laboratoryAvaliação e manejo da dor em pacientes submetidos a procedimentos endovasculares em laboratório de hemodinâmica Evaluación y tratamiento del dolor en pacientes sometidos a procedimientos endovasculares en el laboratorio de cateterismo INTRODUCTIONEndovascular procedures involve the insertion of radiopaque catheters, via percutaneous venous or arterial puncture (femoral, brachial, or radial) under fluoroscopy guidance, to arrive at the desired location (heart, peripheral vessels, cerebral vessels). These procedures are carried out in catheterization laboratories ("cath labs") for purposes both diagnostic (evaluation of blood flow) and therapeutic (treatment of obstructions, stenoses, or correction of aneurysmal lesions) (1) . A common complaint of patients undergoing endovascular procedures is acute pain at the vascular access site or discomfort in the chest and lower back area, which may be related to bedrest, restricted movement of the accessed limb, to the trauma of vascular puncture itself, or to the potential vascular complications that may develop during the procedure (2)(3)(4) . However, other pain complaints, such as back pain or headache, are also very common in this setting (2)(3)(4)(5)(6) . Considering that the high turnover and dynamics of cath lab work may hinder proper care of pain, staff must pay special attention to assessment, management, and systematic recording of pain levels.Despite substantial growth of endovascular procedures in recent decades (3)(4)(5) , assessment of pain in the post-procedural period does not appear to be a major concern of care teams. Few studies have addressed this topic as a primary outcome in this setting (6)(7)(8) ; in others, pain was assessed a secondary or less important outcome (2) . It is known that inadequate management of postoperative pain can prolong hospitalization, increase healthcare expenditures, and have several clinical repercussions, including changes in blood pr...

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The Physiologic Effects of Pain on the Endocrine System

Cited by 97 publications

References 65 publications

Hormone abnormalities in patients with severe and chronic pain who fail standard treatments

Hormone abnormalities in patients with severe and chronic pain who fail standard treatments

Exploring the relationship between disease-related pain and cortisol levels in women with osteoarthritis

Pain assessment and management in patients undergoing endovascular procedures in the catheterization laboratory

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