Presented at the 2013 AAPM Annual Meeting « Back

Medroxyprogesterone Clinical Trial in Intractable Pain Patients

Forest Tennant, MD PhD, veractinc@msn.com¹, (1) Veract Intractable Pain Clinic, West Covina, California

Introduction/Statement of the Problem: Progestins are neuroprotective and neurogenic, so they may provide pain relief and opioid sparing in some patients.1,2 This study was done to determine a possibly effective dosage for the progestin, medroxyprogesterone (MDP). Methods and Materials: Subjects were long-term (over 1 year) intractable pain patients who had likely centralized their pain. All described their pain as constant, debilitating, and required daily, oral opioids at a minimal morphine equivalence of 100 mg a day for pain control. Ten (10) patients were started on MDP at a daily oral dose of 10 mg, and 22 patients were given a topical cream with 30 mg of MDP dissolved in one ounce for daily application. Patients progressively increased their oral dosage over 60 days until they reached a dosage that the patient received to reduce pain, require less opioid use, and cause an increase in energy, mental abilities, or libido. The off-label protocol was approved by the Clinic’s Institutional Review Board. Results: Six (6) of the 10 (60%) patients given oral MDP found 20 to 40 mg a day to be effective. Four reported dramatic reduction in pain and an increase in energy, mental abilities, and libido. Ten (10) of 23 (43.5%) patients who used topical MDP perceived effectiveness particularly for relief of local pain sites. Conclusions: MDP and other progestins warrant clinical investigation for intractable pain patients. References: 1) Roof RL, Duvdevani R, Stein DG. Gender influences outcome of brain injury: progesterone plays a protective role. Brain Res 1993;607(1-2):333-336. 2) Coronel MF, Labombarda F, Villar M, et al. Progesterone prevents allodynia after experimental spinal cord injury. Journal of Pain, Vol 12, No 1 (Jan;) 2011;pp71-83.

Funding: None