Below is an email exchange between myself and Dr. Forrest Tennant, who has been researching the use of HCG for chronic pain, in which he answers several questions I had about the therapy. He is continuing to find it very helpful and feels it should be offered to all patients with "central pain" — the central sensitization that is a part of fibromyalgia. Though still controversial, I agree that HCG is a very reasonable therapy for those with FMS who continue to experience chronic pain despite having followed the SHINE protocol.
If you haven't read my two earlier articles about using HCG for pain, here are the links:
And then my email exchange with Dr. Tennant …
My Letter to Dr. Tennant
Dear Dr. Tennant,
I'd like to thank you for your excellent work over the years. It has been very helpful to both me and my patients. I'm wondering if you could answer a few questions for me?
I recently saw your March 2011 abstract on HCG for pain, and that you had also written on this in 2009. We see in fibromyalgia that testosterone levels are often suboptimal in both men and women, and that low-dose bioidentical testosterone replacement helps (as was seen also in research in a small study by Prof Hillary White in female FMS patients). My questions are:
- Whether the benefits of the HCG may be solely from stimulating testosterone production? Did it help in any patients whose testosterone was already supplemented before the HCG was given?
- Has it helped in any patients not on opioid medications? (I'm wondering if the therapy is largely a matter of reversing a testosterone inhibition caused by the opioids.)
- Are you continuing to see benefit, and are there any side effects from long-term use, besides the acne? Do you continue to recommend it?
Appreciate your guidance.
Love and Blessings,
Dr. Tennant's Response
Your questions on HCG are most pertinent and on target. First, I not only recommend it, but now believe that every patient with central pain should be given a therapeutic trial of HCG [ed-bold italics added]. Central pain is a much more catastrophic and serious condition than formerly recognized. It is fundamentally a focus of neuroinflammation that produces progressive cellular damage and loss of tissue.1-3 At this point in time therapeutic agents with anabolic, nerve regeneration potential should be given every attempt to control central pain and its neurodestructive complications.
First, the ability of HCG to raise testosterone levels in males and females is clearly one, if not its major, beneficial role. I have now used it on patients who have normal testosterone serum levels and some who are on testosterone replacement. Both groups claim additional benefits from HCG. I have 3 patients who adamantly wanted to stay off opioids and have been able to do so with HCG. I now have patients who have taken HCG for up to 2 years without any side effects. In central pain patients, long-term HCG has had the effect of lowering but not eliminating opioid daily dosage, and HCG often obviates the need for testosterone replacement.
It is my belief that HCG not only has testosterone-raising ability, but a neurogenic and anabolic effect on its own. HCG has 2 sub-units. One contains luteinizing hormone, follicle stimulating hormone, and thyroid stimulating hormone. The other unit is anabolic in that it produces neurogenic growth.
As I write this note I'm surveying our long-term (over 6 months) HCG patients to present as a poster at the American Academy of Pain Medicine meeting in February . Hope to have some updated information on dosages, side effects, and outcomes. I'll keep everyone posted.
For more information, here are links to Dr. Tennant's websites:
1. " When good pain turns bad," Watkins LR, Maier SF. Curr Dir Psychol Sci 2003;12:232-236.
2. "Chronic back pain is associated with decreased prefrontal and thalamic gray matter density," Apkarian AV, Sosa Y, Sonty S, et al. J Neurosci. 2004;24(46):10410-10415.
3. "Accelerated brain gray matter loss in fibromyalgia patients," Kuchinad A, Schweinhardt P, Seminowicz DA, et al. Neurosci. 2007;27(15):4004-4007.
Jacob Teitelbaum, M.D. is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of four research studies on their treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.