» Articles » PMID: 25827960

Low-dose Hydrocortisone Replacement Improves Wellbeing and Pain Tolerance in Chronic Pain Patients with Opioid-induced Hypocortisolemic Responses. A Pilot Randomized, Placebo-controlled Trial

Overview
Date 2015 Apr 2
PMID 25827960
Citations 13
Authors
Affiliations
Soon will be listed here.
Abstract

Unlabelled: Long-term opioid therapy has been associated with low cortisol levels due to central suppression of the hypothalamic-pituitary-adrenal axis. The implications of hypocortisolism on wellbeing have not been established. Our aim was to determine whether intervention with physiologic glucocorticoid replacement therapy improves wellbeing and analgesic responses in patients with chronic non-cancer pain on long-term opioid therapy with mild cortisol deficiency. We performed a pilot randomized, double-blind, placebo-controlled crossover study of oral hydrocortisone replacement therapy in 17 patients recruited from a Pain Clinic at a single tertiary center in Adelaide, Australia. Patients were receiving long-term opioid therapy (≥ 20 mg morphine equivalents per day for ≥ 4 weeks) for chronic non-cancer pain with mild hypocortisolism, as defined by a plasma cortisol response ≤ 350 nmol/L at 60 min following a cold pressor test. The crossover intervention included 28-day treatment with either 10mg/m(2)/day of oral hydrocortisone in three divided doses or placebo. Improvement in wellbeing was assessed using Version 2 of the Short Form-36 (SF-36v2), Brief Pain Inventory-Short Form, and Addison's disease quality of life questionnaires; improvement in analgesic response was assessed using cold pressor threshold and tolerance times. Following treatment with hydrocortisone, the bodily pain (P=0.042) and vitality (P=0.013) subscales of the SF-36v2 were significantly better than scores following treatment with placebo. There was also an improvement in pain interference on general activity (P=0.035), mood (P=0.03) and work (P=0.04) following hydrocortisone compared with placebo. This is the first randomized, double-blind placebo-controlled trial of glucocorticoid replacement in opioid users with chronic non-cancer pain and mild hypocortisolism. Our data suggest that physiologic hydrocortisone replacement produces improvements in vitality and pain experiences in this cohort compared with placebo.

Trial Registration: Therapeutic Goods Administration Clinical Trials Notification Scheme (Drugs), Trial Number 2012/0476.

Citing Articles

Opioid-induced adrenal insufficiency: diagnostic and management considerations.

Patel E, Ben-Shlomo A Front Endocrinol (Lausanne). 2024; 14:1280603.

PMID: 38476510 PMC: 10927719. DOI: 10.3389/fendo.2023.1280603.


Iatrogenic adrenal insufficiency in adults.

Martin-Grace J, Tomkins M, OReilly M, Sherlock M Nat Rev Endocrinol. 2024; 20(4):209-227.

PMID: 38272995 DOI: 10.1038/s41574-023-00929-x.


Long-Term Opiate Therapy-Induced Secondary Adrenal Insufficiency: A Distinct Differential Diagnosis That Should Be Considered.

Mohamed Khair A Cureus. 2023; 15(12):e49955.

PMID: 38058524 PMC: 10696915. DOI: 10.7759/cureus.49955.


Adrenal Crisis Masked as Septic Shock in a Patient With Opioid Use Disorder on Buprenorphine.

Ebersole A, McKnight L, Vijayaraman A, Guarneri A, Bonny A Cureus. 2023; 15(7):e41794.

PMID: 37575858 PMC: 10421734. DOI: 10.7759/cureus.41794.


A Closer Look at Opioid-Induced Adrenal Insufficiency: A Narrative Review.

Coluzzi F, LeQuang J, Sciacchitano S, Scerpa M, Rocco M, Pergolizzi J Int J Mol Sci. 2023; 24(5).

PMID: 36902007 PMC: 10003084. DOI: 10.3390/ijms24054575.