Twin Chronic Pain Study – Low DHEA Metabolite and High BMI and ?Cortisone

Twin study shows low Epiandrosterone, a metabolite of dehydroepiandrosterone (DHEA). Could supplementation help?

PAIN Publish Ahead of Print 2015
DOI: 10.1097/j.pain.0000000000000200

An  omics  investigation  into  chronic  widespread  musculoskeletal  pain  reveals  epiandrosterone sulfate as a potential biomarker
Gregory Livshits et al
http://www.ncbi.nlm.nih.gov/pubmed/25915148

  • Adult female twins (n=2,444) from  TwinsUK registry; KORA = 1231 men and 1252 from German study
  • screened 324 metabolites
  • BMI (Fat mass/height) most strongly related to chronic musculosketal pain
  • “epiandrosterone sulphate (EAS) was highly associated [in being low] with both CWP (p=1.05 x 10 in TwinsUK and p=3.70×10 in KORA)”
  • Cortisol was only marginally related when obesity taken into account:
    CWP [chronic widespread pain] was associated with cortisone levels on metabolomic screen (p=0.00069), the association was only marginally statistically significant when adjustment was made for FMI [fat mass index](p= 0.052)’
    – however who is to say, that part of the effect of obesity on chronic pain, is not mediated through low cortisone

Comment –  I use DHEA in the treatment of depression in older patients with low levels:

  • Wolkowitz, Owen M., et al.
    Dehydroepiandrosterone (DHEA) treatment of depression.
    Biological psychiatry 41.3 (1997): 311-318.
    http://www.sciencedirect.com/science/article/pii/S0006322396000431
    – gave 30-90 mg/day X 4 wks  6 older pateints, some treatment resistant
    – got improvment though 1 case took 6 months so don’t know it related
  • Wolkowitz, Owen M., et al.
    Double-blind treatment of major depression with dehydroepiandrosterone. American Journal of Psychiatry 156.4 (1999): 646-649.
    http://www.ncbi.nlm.nih.gov/pubmed/10200751
    -gave up to 90 mg/day DHEA X 6 wk
    – “Five of the 11 patients treated with DHEA, compared with none of the 11 given placebo, showed a 50% decrease or greater in depressive symptoms.”
  • Rabkin, Judith G., et al.
    Placebo-controlled trial of dehydroepiandrosterone (DHEA) for treatment of nonmajor depression in patients with HIV/AIDS.
    American Journal of Psychiatry 163.1 (2006): 59-66.
    http://www.ncbi.nlm.nih.gov/pubmed/16390890
    -100-400 mg/day for 8 wks
    – response rate was 56% for the DHEA  vs 31% placebo group
  • Schmidt, Peter J., et al.
    Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression.
    Archives of general psychiatry 62.2 (2005): 154-162.
    http://archpsyc.jamanetwork.com/article.aspx?articleid=208294
    -DHEA 90 mg/d for 3 weeks and 450 mg/d for 3 weeks
    -BDI (beck depression inventory)  dropped from 17.2(mild)  to 10.1 vs 13.3 in placebo (p<0.01)

Unfortunately, a trial of 50 mg tid in Fibromyalgia failed to help
Finckh, Axel, et al.
A randomized controlled trial of dehydroepiandrosterone in postmenopausal women with fibromyalgia.
The Journal of rheumatology 32.7 (2005): 1336-1340.
http://www.jrheum.org/content/32/7/1336.short

  • “After 3 months of treatment with 50 mg of DHEA, median DHEA sulfate blood levels had tripled, but there was no improvement in well-being, pain, fatigue, cognitive dysfunction, functional impairment, depression, or anxiety, nor in objective measurements made by physicians. “
  • “Androgenic side effects (greasy skin, acne, and increased growth of body hair) were more common during the DHEA treatment period (p = 0.02)”

So it might be more useful; in depressed cases for the mood. People in US can just order it. In Canada, I have people order it in through ebay from the US but have it sent c/o my office otherwise it will be rejected. I use 100 mg tid and find it helpful with no side effects I have seen. So it is possible it could help the depression in chronic pain patients; whether it helps the pain, someone will have to study…

I they have – let me know! canada goose prix canada goose prix

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