Hormones and Their Interaction with the Pain Experience By Dr. Joe Tatta, DPT

If you struggle with chronic or persistent pain, you’ve probably been in and out of many doctor’s offices yet never feel as if you have received a good solution. Unfortunately, over 100 million people who live with persistent pain share that same story. Persistent pain has a number of underlying sources, with hormones and their relative balance playing an important role.

If pain has been present for more than three months, central sensitization has probably occurred, which means tissue damage and inflammation are no longer the only causes of pain. At this point, processes deep within the brain, as well as thoughts, emotions, or negative cognitions may be contributors to producing pain. Numerous studies have demonstrated the association between pain, fear-avoidance, and negative coping.¹Crofford, L. J. “Chronic pain: Where the body meets the brain.” Transactions of the American Clinical and Climatological Association 126 … Continue reading When the threshold for danger is significant enough your brain decides it may be beneficial for you to feel physical pain.

The signals and function of your hormones exert a strong influence over central sensitization, thus a chronic hormonal imbalance may lower your pain threshold. Here’s a look at the connections between certain hormones and pain, and since you follow the work of Dr. Sara Gottfried MD, you’ll recognize them as the Hormonal Charlie’s Angels:

1. Estrogen: For females, estrogen is important for its ability to reduce the sensation of harmful stimuli and pain signaling. If estrogen levels decline (and they do with age), the pain management benefit of estrogen declines as well. With restoration of appropriate estrogen levels, pain modulation benefits return.²Gintzler, A. R., et al. “Importance of sex to pain and its amelioration; relevance of spinal estrogens and its membrane receptors.” … Continue reading
2. Thyroid hormones: An overactive thyroid is associated with increased excitability in the brain and spinal cord, which contributes to a lower threshold in central sensitization. Increased thyroid concentrations in the brain reduce binding sites for GABA, a naturally occurring neurotransmitter that calms the brain. Conversely, with hypothyroidism, regional hypoxia (tissues not getting enough oxygen) may develop, which may lead to muscle spasms, cramps, and pain.³Aloisi, A. M., et al. “Pain and thyroid hormones.” Neurological Sciences 34, no. 9 (2013): 1501-1508.
3. Cortisol: This hormone is key for healing, but when levels are high from living in a “hypervigilant” or continually stressed state the threshold for pain is lowered. A benefit of cortisol is that its presence helps protect our brain from forming traumatic memories, but researchers have shown a significantly higher memory recall of trauma when cortisol is low.⁴Hauer, D., et al. “The role of glucocorticoids, catecholamines and endocannabinoids in the development of traumatic memories and posttraumatic … Continue reading As this decline progresses the anti-inflammatory benefits are lost. A 2014 study showed that hypocortisolism was also associated with higher levels of pain.⁵Godfrey, K. M., et al. “Salivary cortisol and cold pain sensitivity in female twins.” Annals of Behavioral Medicine 47, no. 2 (2014): … Continue reading

HPA Axis

The HPA axis is composed of the hypothalamus, the filter that provides information to the pituitary gland, which in turn releases several hormones, which result in a specific response of the target tissue. The “A” refers to one of the areas receiving those signals, the adrenal glands, but the others include; thyroid, gonads (ovaries or testes), liver, mammary glands, and adipose tissue.

Problems arise with a decline in function of the HPA axis, which has been associated with the development of chronic pain, fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, and temporomandibular disorder. As the signaling mechanisms and feedback loops become dysfunctional, hormone levels cannot be regulated. Anyone who suffers any level of centralized pain needs to address the dysfunction of the HPA axis.⁶Hannibal, K. E., et al. “Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain … Continue reading Chronic stress is one of the biggest enemies of HPA axis health.⁷Belda, X., et al. “Stress-induced sensitization: the hypothalamic–pituitary–adrenal axis and beyond.” Stress 18, no. 3 (2015): … Continue reading

Five key steps can help balance hormones and reduce persistent or chronic pain.

1. Modulate stress and improve sleep. The perception of stress is more important than the stress itself, but changing perception takes time and examination of your responses. Try to continually look at your responses as an impartial bystander. If you were to see someone respond how you just did, would you think it appropriate?In addition to stress reduction, proper sleep is powerful, providing strong support to a multitude of systems, especially maintenance of the HPA axis and rejuvenation of the brain. Poor sleep is associated with increased sensitivity to pain. Try going to bed at the same time every night and sleeping for eight to nine hours for a week; you will be surprised how much better you feel.⁸Sivertsen, B., et al. “Sleep and pain sensitivity in adults.” Pain 156, no. 8 (2015): 1433-1439.
2. Start moving again. Movement is abundantly important for the body. With chronic pain, the body is usually imbalanced so healthy functional movement must be restored before engaging in an exercise program. At this stage, enlist an expert to guide your body back to a higher functional capacity. Excellent options include physical therapy, Pilates, yoga, tai chi, walking, or a gentle bike riding. Once you’ve restored healthy movement, you can begin an exercise program to build strength and vitality. Strength training and high-intensity interval training (HIIT) are both great options, but ensure that your body is ready for increased demands of higher intensity exercise.⁹Clauw, D. J. “Fibromyalgia: a clinical review.” Journal of the American Medical Association 311, no. 15 (2014): 1547-1555.
3. Heal with food. Food sends powerful signals to every tissue in your body. What type of signals do you want to send? Eating real, whole foods provides nutrients, such as antioxidants and trace minerals, which support appropriate signaling to the brain in the pain pathway.¹⁰Evans J. G., et al. “Redox and trace metal regulation of ion channels in the pain pathway.” Biochemical Journal 470, no. 3 (2015): 275-280. The human body is not well equipped to handle highly processed foods. The potent impacts can increase inflammation¹¹Myles, I. A. “Fast food fever: reviewing the impacts of the Western diet on immunity.” Nutrition Journal 13, no. 1 (2014): 1., dysregulate blood sugar, cause insulin resistance and pave a path to obesity and diabetes.¹²McEvoy, C. T., et al. “A posteriori dietary patterns are related to risk of type 2 diabetes: findings from a systematic review and … Continue readingCertain individuals will need to go a step farther and implement an elimination diet. The goal of an elimination diet is to identify and remove categories of food that your body can not tolerate.¹³Tick, H. “Nutrition and Pain.” Physical Medicine and Rehabilitation Clinics of North America 26, no. 2 (2015): 309-320. Foods to consider eliminating include: gluten, dairy, eggs, GMOs, and processed sugars as they carry the highest likelihood of impacting the perception of pain.Another diet option is to follow a ketogenic plan, which has to potential to decrease the excitability of neurons, which is a central tenet to the development of central centralization.¹⁴Masino, S. A., et al. “Ketogenic diets and pain.” Journal of Child Neurology (2013): 0883073813487595. While our current understanding of why the ketogenic diet impacts pain is low, there may be a connection to this dietary plan’s ability to improve the management and metabolism of cortisol.¹⁵Stimson R. H., et al. “Dietary macronutrient content alters cortisol metabolism independently of body weight changes in obese men.” Journal of … Continue reading
4. Get your mind right. Since pain is both a sensory and emotional experience, addressing the emotional component carries tremendous importance. Confronting both present and past trauma will help quiet a sensitive nervous system. Multiple options exist to address the emotional component of the trauma including: cognitive behavioral therapy, acceptance and commitment therapy, progressive relaxation, and spiritual practices. Look for qualified clinicians in your area.¹⁶la Cour, P., et al. “Effects of mindfulness meditation on chronic pain: a randomized controlled trial.” Pain Medicine 16, no. 4 (2015): … Continue reading
5. Targeted nutrition. Every single nutrient that goes into the body sends a signal to your cells, organs, and nervous system. At times the signal volume needs to be turned up with dietary supplements targeted to a specific need. The following supplements help when there is a hormonal connection to pain:

Fish Oil: 2,000-3,000 mg/day of EPA and DHA, supports the natural anti-inflammatory responses in the body, providing resolution of inflammation and supports tissues return to balance.

Curcumin: 500mg 2x/day of Bioavailable Form, a potent antioxidant and anti-inflammatory with systemic benefits to the brain, muscles, and joints.¹⁷He, Y., et al. “Curcumin, inflammation, and chronic diseases: how are they linked?” Molecules 20, no. 5 (2015): 9183-9213.

GABA: 200mg as needed, a naturally occurring chemical in the brain promoting a calm brain and reducing mild stress and anxiety.¹⁸Benson, C., et al. “Biogenic amines and the amino acids gaba and glutamate: relationships with pain and depression.” Pain in Psychiatric … Continue reading

L-Theanine: 200mg 1-2x/day, an amino acid found in green tea and known to induce relaxation without drowsiness.¹⁹Lardner, A. L. “Neurobiological effects of the green tea constituent theanine and its potential role in the treatment of psychiatric and … Continue reading

Chronic or persistent pain is both an emotional and sensory experience with many contributing factors. Balancing hormones is one important step toward a pain-free life. Remember, the pain you feel is real and an alarm that something in your body and brain needs attention and care. Understanding and healing the root cause of your pain often takes an integrated approach. A skilled practitioner can identify and examine the problem through a functional lens.

Dr. Joe Tatta is a doctor of physical therapy, board certified nutrition specialist and functional medicine practitioner who specializes in treating persistent pain and lifestyle-related metabolic and autoimmune health issues. His mission is to create a new paradigm around treating persistent pain and reverse our global pain epidemic. He is the creator of the Healing Pain Online Summit and The Healing Pain Podcast designed to broaden the conversation around natural strategies toward solving persistent pain. Dr. Tatta is the author of the soon to be released book Heal Your Pain Now; A revolutionary program to reset your brain and body for a pain-free life by Da Capo Press. He is currently in private practice in New York City, New York, and also provides Online Health Consulting to help people achieve their optimal level of vitality and freedom from chronic disease. Learn more by visiting http://www.drjoetatta.com.