Presented at the 2012 AAPM Annual Meeting « Back

Clinical Trial of Progesterone for Central Intractable Pain

Forest S. Tennant, MD DrPH, veractinc@msn.com, Veract Intractable Pain Clinic, West Covina, California

Introduction/Statement of Problem: Military returnees from Iraq and Afghanistan with high pain levels have low serum levels of allopregnanolone, the metabolite of progesterone.1 Animal studies show that progesterone has a regenerative effect on neural tissue.2,3 Clinical trials in pain patients should now be done. Materials and Methods: After Institutional Review Board approval, 5 (3 females, 2 males) patients with presumed central, intractable pain and maintained on opioids for over 2 years were given 10mg twice a day of medroxyprogesterone (MDP). Patients had constant pain for at least 3 years, gave a history of periodic allodynia and hyperalgesia, and had failed multiple peripheral pain treatments. If there was no response to MDP after 30 days, the dosage of progesterone was raised to 30 or 40mg a day. Results: After 3 months all five patients reported that they felt better, were less depressed, and desired to continue MDP. Three patients reported a 30 to 50% and 2 a 10 to 30% drop in their constant pain intensity. Both males reported an increased libido. No side-effects were observed. Conclusions: The small, pilot study suggests that progesterone may have a regenerative or ameliorative effect on central, intractable pain, and further clinical trials are warranted. References: 1). Kilts, et al. Neurosteroids and self-reported pain in veterans who served in the Military after September 11, 2001. Pain Med 2010;10:1469-1476. 2)Roglio, et al. Neuroprotective effects of dihydroprogesterone and progesterone in an experimental model of nerve crush injury. Neuroscience 2008;26:673-685. 3)Coronel MF, et al. Progesterone prevents allodynia after experimental spinal cord injury. J of Pain 2011;12:71-83.

Funding: None