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Wednesday, February 29, 2012

HCG and pain management

Recently I have had a great deal of patients with chronic pain.  The patients have been taking opioid pain medication and have seen relief but interestingly, they dosage has always needed to be increased.   Lets see what role HCG plays.  This article caught my attention because for a few years I owned and operated a successful HCG weight loss clinic out of my office and saw amazing results.
According to an article in Practical Pain Management, the FDA removed homeopathic HCG from many markets in order to help legitimate use in pain management.
Chemically HCG, is made up of two amino acid subunits labeled a and b.  One unit contains amino acid sequences that are identical to folllicle stimulating hormone, luteinizing hormone and thyroid stimulating hormone.  Consequently, HCG stimulates the gonads, adrenal glands and thryroid to secret a number of hormones, including testosterone.  The other subunit of HCG is an anabolic agent.  It increased cyclic adenosine monophosphate or (cAMP) and nitric oxide (NO).  4 cAMP is known to be critical element in tissue production and NO is known to increase blood flow.  There are HCG receptors throughout the body, including in the central nervous system (CNS).  Animal studies show that it has considerable neurogenic properties.  Patients with central pain develop hormonal deficiencies and have a need to regenerate CNS tissue.  Studies show that testing for pituitary-adrenal-gonadal deficiencies; physician supervision is recommended when prescribed.  Below are some key points that summarize HCG's use in pain management:
* No claims of pain cure are made.  HCG in pain management is an adjunct to standard therapy when hormonal deficiencies are apparent.
* Unquantifiable dosages such as "homeopathic" are not acceptable, as we must know the precise dosages of every medication we prescribe.  After all, a patient with chronic pain may be concomitantly taking multiple agents (eg, opioids, neuropathic compounds and anti-inflammatory drugs) and we must constantly monitor for effectiveness, side effects and interactions.
*As a highly active hormonal substance, HCG must be prescribed and monitored by a physician and not sold for self-help purposes.
*A 500 calorie diet is inappropriate in the vast majority of patients with chronic pain, as some are malnourished and even in a catabolic state because of poor dietary habits.
*One of the labeled indications for HCG is hypogonadism.  Low serum testosterone levels are common in male and female pain patients who take opioids and other agents.  Unfortunately, sever pain, per se, as well as many other pharmaceutical agents cause pituitary insufficiencies and require hormonal replacement.
*Any physician can use a marketed pharmaceutical off label as long as he or she does not make any public claim or advertise about off label use.  Advising the patient that the pharmaceutical is being used in an off label manner is recoommended.  Be it clearly states here that there is no clain of pain cure for HCG or that it is a substitute for standard pain treatment measures.

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