Joe has chronic fatigue, weakness, and erectile dysfunction. He was doing well until 10 years ago when he started pain pills after a car accident which left him with chronic back pain.
Chronic Pain Treated with Opioid Narcotics
After the car accident, Joe’s family doctor prescribed oxycontin pain pills, hoping the chronic back pain would eventually get better. Unfortunately, Joe’s back pain did not get better, and he still takes pain pills every day. Even though the pain pills are no longer effective, Joe finds it nearly impossible to get off them because of the severe withdrawal effects.
Low Testosterone Detected on Blood Tests
Joe’s lab testing showed very low testosterone levels. This explained the fatigue, weakness and low libido. Joe was started on bioidentical testosterone as a topical gel, and 6 weeks later he reports that his fatigue and weakness is gone, and his wife is much happier with his renewed libido. Joe also noticed his chronic pain seemed to decrease in intensity, and he was now interested in pursuing the idea of tapering off the narcotic pain pills.(4)
Doctors Freely Prescribe Narcotic Pain Pills
When patients like Joe seek help from their doctor for a painful condition, they will be given narcotic pain tablets such as percocet, oxycodone, roxycodone and oxycontin. These pain pills are quite effective at relieving the painful condition. However, they come with severe adverse side effects.
Adverse Effects of Long Term Pain Pills (Opiates)
We all know that Pain Pills, such as opioid narcotics, are highly addictive and come with severe adverse effects. Opiate containing narcotic Pain Pills were never intended for long term use. They cause profound suppression of the endocrine system, and in men, profound inhibition of testosterone production. This type of low testosterone is quite common, and yet, may go unrecognized by the busy primary care doctor. (1)
Another adverse effect of long-term opioid use is opioid-induced hyperalgesia. This is a form of hypersensitivity to pain. The original painful condition becomes worse. Other adverse effects include impaired cognitive function, and suppression of the immune system with tendency to develop infection.(6)
Chronic Opioid Pain Pills Lose Effectiveness Long Term
Another problem with long term use of narcotic pain pills, is that they lose their effectiveness over time. The brain and nervous system develops a "tolerance" to the drug, and higher doses are required to achieve the same result.(7) The initial pain relief from opioid pain pills may not be sustained long term because of drug tolerance, opioid-induced hyperalgesia, and intermittent drug withdrawal effects. (7) In other words the pills lose their effectiveness, and yet continue to produce dependence and adverse effects.
Low Testosterone Goes Largely Unrecognized
Although quite common, Opioid-induced androgen deficiency and has gone largely unrecognized by the medical community(1). Low testosterone is caused by opioid drug inhibition of LH (Leutininizing Hormone), a pituitary hormone involved in testosterone production, as well direct inhibition of testosterone itself. Similarly, there is also inhibition of the entire endocrine system, and adrenal hormone suppression.
Symptoms of low testosterone include fatigue, depression, hot flashes, night sweats, diminished libido, erectile dysfunction, and diminished sexual arousal and satisfaction. Men may also develop osteoporosis, anemia, and diminished muscle mass. (2)(3) Women who consume opioid-pain pills will stop having menstrual cycles and will notice greatly diminished libido (sex drive). (5)
Testosterone Treatment Effective and Recommended by Mainstream Medicine
Administration of topical testosterone, or injectable testosterone has been studied and found effective for men with low testosterone on pain pills. (4)
Our Approach to Evaluation and Treatment
For men with a chronic pain condition who have been on long-term pain pills, our evaluation includes a complete blood testing panel looking for vitamin, mineral and nutritional deficiencies. We find these deficiencies quite commonly in this group. In addition, evaluation includes a complete hormone panel looking at the entire endocrine system, and adrenal function. If extensive testing shows low hormone levels, then hormone supplementation is offered.
Opiate Detoxification Program is Essential
The reality is that hormone supplementation and nutritional supplementation for the long term opiate pain pill user is only a temporary bandaid. To fully restore health, the opiate addiction must be addressed and the patient must ultimately get off the pain pills. This may be difficult to do on their own because of severe drug withdrawal symptoms. Therefore, we provide the patient with a referral to any one of a number of doctors who specialize in narcotics detoxification, and urge the patient to strongly consider this.
For references, or additional information, visit: www.jeffreydach.com.
Jeffrey Dach MD is founder of TrueMedMD, a clinic in Hollywood, Florida specializing in Bioidentical Hormones and Natural Thyroid. Originally Board Certified in Diagnostic and Interventional Radiology, Dr. Dach is also Board Certified by the American Academy of Anti-Aging Medicine.
Dr Dach is author of the book, Natural Medicine 101, available on Amazon or as a free e-book at www.naturalmedicine101.com.
His office is located at 4700 Sheridan Suite T, Hollywood Florida 33021. Telephone 954-983-1443.
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