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Your search was for "pain".
Found 73 matches in 26 Q&A's.


1) Q&A from the March, 2004 NADF newsletter:

QUESTION: My adult son developed Addison's disease not too long after falling off a ladder while painting his house. Is there any chance this could be the cause of his Addison's.

ANSWER: Severe injury that causes hemorrhage into both adrenal glands can cause Addison's disease. It is more likely to occur in people with abnormal clotting factors that make them more susceptible to hemorrhage and bleeding. There have been reports of transient as well as permanent adrenal insufficiency from hemorrhage. The best way to document it is a CT at the time of diagnosis, which will show enlargement of the adrenals from the hemorrhage. Autoimmune Addison's would show tiny adrenals. Also, a blood test for antibodies to 21-hydroxylase is useful to rule out autoimmune Addison's and would be negative if caused by the trauma.



2) Q&A from the September, 2004 NADF newsletter:

QUESTION: Would physical therapy ever be prescribed for the lower back pain associated with Addison's symptoms? How can you differentiate a spinal injury from Addison's-type muscle pain?

ANSWER: Back pain is seen in some people with untreated Addison's disease or during an adrenal crisis. It should not be considered a chronic feature of Addison's disease. Therefore, if persistent back pain is present in an addisonian who is on appropriate replacement steroids, other causes should be sought and treated, with physical therapy, pain management, etc.



3) Q&A from the March, 2006 NADF newsletter:

QUESTION: I have had Addison's disease for 20 years. I am needing any information anyone can give me on joint pain, osteoporosis and long-term steroid use. Since being on steroids for 20 years, I have severe back (discs) and joint pain to the point I can't stand or sit for even short periods of time. I am needing proof that the steroids could have caused this problem. Can you please help - do you have any info on this or suggested books I could read or recent studies on long-term steroid use.

ANSWER: There is a lot of confusion and misinformation about steroids and arthritis as well as osteoporosis. High dose steroids, as used to treat illnesses like asthma, rheumatoid arthritis and ulcerative colitis, will cause osteoporosis (bone thinning) and increase the risk of fractures. This can now be prevented with drugs like Fosamax and Actonel. Replacement steroids to treat Addison's disease are much less likely to cause osteoporosis because a lower dose is used that is meant to replace what is missing from the adrenals. The only study of osteoporosis in Addisonians showed only a mild tendency in men, not women. Arthritis is not caused by steroids. As noted, it is used to treat the inflammation of rheumatoid arthritis. The only joint complication of steroids is the rare occurrence of avascular necrosis of a joint, especially the hip, where the circulation to the bone is damaged, resulting in a sudden loss of a part of the bone within the joint. Avascular necrosis is most commonly seen in people given high dose steroids to treat medical conditions, but has rarely been reported in Addison's disease. Most likely the back pain and other joint pain you have is due to other factors. It is unlikely to be due to the Addison's treatment.



4) Q&A from the March, 2006 NADF newsletter:

QUESTION: My daughter was recently diagnosed with Schmidt's syndrome. In addition, she has had a headache for over a year. The headache gets somewhat better at times, and is worse at others, but never goes away. We still do not have a diagnosis on the headache, although tension seems to be a significant contributor. Due to the headache pain and the fatigue associated with Addison's, she has become depressed. Could the Addison's and Hashimoto's be causing her headache? She had scoliosis surgery a year ago in November and now has two Titanium alloy rods in her back. Could a metal allergy have caused the onset of Addison's? She developed low blood pressure and orthostatic intolerance two weeks after surgery. Could this have actually been an Addison's crisis and we are just fortunate that she still was making enough Cortisol to get through the surgery? Could a difficult menstrual cycle be stressful enough to require an extra 5mg of cortisol?

ANSWER: Depression is common in individuals with inadequate treatment of both adrenal insufficiency and hypothyroidism, but it is also common in the general population and in the setting of chronic illness. Headache can also be seen in hypothyroidism. Metal allergy is not a known cause of adrenal insufficiency. Certainly, hypotension after surgery may have been a sign of adrenal insufficiency at that time. Yes, menstrual cramps can be severe enough to require extra steroid treatment. Try a dose of ibuprofen at the onset of the cramps to minimize the pain.



5) Q&A from the March, 2007 NADF newsletter:

QUESTION: Is Addison's Disease getting in the way of me healing from a herniated disc? Is the medicine I am on going to interfere with any pain pills I might be on? I am on hydrocortisone 20mg am/10mg pm fludrocortisone acetate 0.1 am Synthroid 112mcg am. What pain pills would help if I have a choice to go on any? Sometimes the pain can be very intense.

ANSWER: I cannot advise you about which pain medication is appropriate for you. I can tell you that pain is a stress that often makes your body need more steroid hormone. If you notice more fatigue, loss of appetite, nausea or dizziness, these are signs indicating you need more hydrocortisone. Also, some narcotic pain medications increase the rate of metabolism of the hydrocortisone, which may also make you need a higher dose. The actual healing of the disc problem will not be affected by the Addison's disease.



6) Q&A from the December, 2007 NADF newsletter:

QUESTION: I have just visited my new dentist and again, as with my other dentists, I was given an article on the dangers of using bisphosphonates such as Actonel and Boniva which I have been taking. In June 2006 when I first received this warning, I stopped taking them for six months. My doctors said this warning was mainly for cancer patients and I should continue the drug to prevent bone loss. My bone density test in December 2006 was good for my age and arthritis I have. I do take 1500 mg of calicium with viatmind D daily. My question is — should I continue with Actonel or Boniva? If so, whch do you reocemmend. Also, I suffer from back problems which it seems Addisonians are prone to. The MRI's do not reflect a cause for my type of terrible pain. My hips are fine. I am on 7 mgs. of prednisone; 0.1 mg am + 0.05 mgs fludrocortisone acetate (Impax - Global); 125 mcg Synthroid; 2-3 - 50 mgs of tramadol; 200 mg's Celebrex at night and sometimes 5mg Ambien to help sleep with pain. A multivitamin; the Calcium with D and Omega 1000. My question is: Do you think when I gave up my Premarin three or four years ago, did this cause my pain? Addisonian's don't make hormones that I know of. Could it be possible I need them? Could the lack of hormone be causing my pain? My doctor says, “we just don't know". So I would like your opinion. Thank you.

ANSWER: The back pain and risk of osteoporosis are totally separate. Osteoporosis does not cause symptoms unless there is a fracture. Arthritis, which is not part of the osteoporosis, causes pain. If you do have osteoporosis, you should take the calcium and vitamin D as well as a bisphosphonate. It can be Fosamax, Actonel or Boniva. They all work well to reduce the risk of fracture. They will not help with your back pain. The fear that the dentist has caused is totally inappropriate. The risk of osteonecrosis of the jaw is extremely unlikely with oral bisphosphonates. The only reason the dentist should be involved is if you actually have osteonecrosis, in which case you should stop the medication.



7) Q&A from the March, 2009 NADF newsletter:

QUESTION: I have had Addison's disease since 1969 and I am 73 years old. I have always been active. This year, it is harder to do things and a lot of muscle and joint pain, which I take pain meds for. My question: Does age ever require an increase in steroids? I take 25 mg. cortisone acetate in the am and 12.5 mg pm. I also take 0.1mg fludrocortisone acetate and 0.1 mg. synthroid. Thank you.

ANSWER: There is no general tendency to need a higher dose of replacement glucocorticoid with aging. The aches and pain are more likely the normal symptoms of arthritis rather than adrenal symptoms. Discuss the symptoms with your doctor. You might benefit from a consultation with a rheumatologist.



8) Q&A from the September, 2011 NADF newsletter:

QUESTION: I have adrenal insufficiency, diagnosed about 5 years ago. I always have a problem with doctors & health care professionals not knowing much about this disease & especially not knowing the protocols for adrenal insufficient patients when running tests and procedures. My Gastro doctor has ordered a Gastrografin Enema for me. I don’t know much about this test. I have asked the radiologist questions, but he really can't help me in finding out if I will need any kind of hydration or steroids during this test. Can you help me out? Are you aware of any protocol that needs to be followed for this test, for me?

ANSWER: An enema to look at the colon is not a very significant stress. I would expect that you might need to be on a liquid diet for a day, but as long as you are well hydrated at the time of the procedure, it is unlikely that extra IV fluids or steroids would be needed. However, if you are dealing with any pain or serious discomfort, a slight increase in oral hydrocortisone before the procedure would be safe.



9) Q&A from the June, 2013 NADF newsletter:

QUESTION: I’ve been on prednisone non-stop for about 20 years for asthma. I was very slowly weaned to 7.5 mg every other day, a level I’ve been on for 3-5 years. Periodically I have to bump up the levels, and in the past 4 months I’ve had to bump them up and return to every day usage 3 times for asthma flares related to bronchial/lung infections. About 6 weeks ago I had a flare which required me to take the prednisone every day, in doses as high as 60 mg. It took about a month to get back to the 7.5 mg every other day. (I also have ulcerative colitis, but my primary medication for that is immuran.) Then I saw a new pulmonolgist. She asked me to reduce prednisone by 2.5 mg per week, becoming steroid free in a month. Her only warning about adrenal insufficiency regarded lightheadedness upon rising from a supine position. However, I wonder if that reduction is too fast, and if I should have blood tests to help guide the weaning. I am using 5 mg every other day now, but I have noticed weakness in my knees that I have associated with changes in steroid use in the past. I also have noticed new pain in my left hip, which I had not thought related, but now I wonder.

ANSWER: This is an example of the difficulty in tapering off long term steroids. I agree that the new pulmonary doctor may be too optimistic about your ability to taper and stop steroids after so many years of use and the frequent need to bump up to high doses. Going rapidly to every-other-day dosing in this situation is probably complicating the situation and contributing to the adrenal insufficiency symptoms (like the muscle weakness). Every other day dosing is useful in people who have been on steroids for a fairly short period of time, like a few weeks. In this current case, there is a great degree of adrenal suppression, so a slow taper of daily dosing has a greater chance of working. Once a dose of 5 mg is achieved, going down by 1/2 to 1 mg every 2 to 3 weeks may work better. Blood testing is not very useful, except for a morning ACTH once the dose is down to 2 or 3 mg, just to see if there is evidence of “awakening” of the pituitary. If ACTH is measurable, it is more probable that secondary adrenal insufficiency may resolve. Keep in mind that after 20 years of steroid use, many people have permanent secondary adrenal insufficiency and must settle on a baseline replacement dose of 4-5 mg of prednisone.



10) Q&A from the September, 2013 NADF newsletter:

QUESTION: I’m an Addisonian, and also a sufferer of chronic pain. I feel like one can affect the other sometimes. Are the two in some way related, or can chronic pain lead to adrenal failure over a period of time?

ANSWER: pain is a stress that can affect the management of Addison’s disease, and opiates prescribed for chronic pain can affect the metabolism of replacement steroids. But, pain does not cause the destruction of the adrenal glands.



11) Q&A from the December, 2013 NADF newsletter:

QUESTION: I was diagnosed with Addison's in 1971. Recently, I underwent surgery to treat breast cancer, followed by radiation treatment. The cancer was luckily caught in stage one. I felt great until they put me on Arimidex. After that, I felt terrible and had every symptom of my Addison's return even though I was on cortisone replacement. They took me off Arimidex, and put me on Tamoxifen. The same thing happened, and I was getting so sick that I went into adrenal crisis multiple times. Is this a known complication of those two drugs?

ANSWER: This is not a common event. Arimidex blocks aromatase, which is needed for the production of estrogen. Tamoxifen blocks the estrogen receptor. Neither should have a direct effect on cortisol metabolism. I suspect that the known side effects of these medications, which include aches and pains, might have felt like adrenal insufficiency. The pain itself will cause a need for additional doses of steroids.



12) Q&A from the March, 2014 NADF newsletter:

QUESTION: I have adrenal insufficiency as well as numerous other medical conditions. I experience chronic pain because of those conditions, and have been taking opiates for years to manage it. Due to a problem with supplying my pain medication, I have been approached with the idea of using naltrexone to try and quickly break my dependency on opiates. There is not yet a plan for a replacement method to treat my pain. What is your opinion of using naltrexone therapy as an adrenal insufficient patient?

ANSWER: Using naltrexone is certain to cause severe pain. It is very important to manage the use of any narcotic with adrenal insufficiency. Narcotics can increase metabolism of glucocorticoids, and not enough of either pain medication or cortisol can further increase pain. Finding a balance is difficult, requiring frequent adjustments to dosages of pain medication and steroids. However, I cannot recommend using naltrexone if the opiates you are on are necessary to fight chronic pain. Naltrexone is usually only used for overcoming narcotic addiction, and it sounds like you need pain management. Without pain management, naltrexone will only further complicate your adrenal insufficiency since pain is a severe stress.



13) Q&A from the September, 2015 NADF newsletter:

QUESTION: I am aware of recommended surgery protocol for adrenal insufficient patients. Are there recommendations for the 2nd and 3rd day post-surgical, bilateral knee replacement therapy as one begins ambulation?

ANSWER: The speed of steroid taper post-op depends on the severity of the post-op stress, which usually means pain. After knee replacement, narcotics are typically used, and these affect the steroid dosage indirectly. It would be common to need a double oral dosage for the first 2 or 3 days post-op. If pain is well controlled, a taper to 1 and 1/2 of the usual oral dose may be needed for several more days until pain is limited. If there are any surgical complications, such as infection, a return to higher stress doses would be needed. When in doubt, if any adrenal insufficiency symptoms occur, such as nausea or dizziness, continue to take extra glucocorticoids.



14) Q&A from the March, 2016 NADF newsletter:

QUESTION: I have a kidney stone, my first one ever, and the stone has not passed yet. They want to talk about procedures to remove the stone. I would like to know if I need to be on cortisol during any type of kidney stone procedure. I have secondary Addison’s.

ANSWER: Yes, steroid coverage is needed for any surgical procedure. The urologist will be familiar with this. A dose of 50 to 100 mg of hydrocortisone at the time of anesthesia and follow up doses depending on whether there is much post-op pain should be given.



15) Q&A from the September, 2016 NADF newsletter:

QUESTION: What is your medication guidance regarding wisdom teeth extractions for AI patients?

ANSWER: Steroid coverage for wisdom teeth extraction depends on the type of anesthesia being used and the expected degree of post-op pain. If general anesthesia is needed, I would suggest IV hydrocortisone 50 mg to be given at the time of anesthesia. If local anesthesia is used, oral hydrocortisone 20 mg before the procedure should be sufficient. Post-op, extra oral hydrocortisone of 10 to 20 mg can be added a few hours later, depending on the severity of pain.



16) Q&A from the December, 2016 NADF newsletter:

QUESTION: Someone on one of my support forums gave me your site to contact because of recurring issues with ACTH levels. Just a bit of history for you so that you can help me as much as possible. I am a 43 year old female that was diagnosed with Cushing's syndrome due to both an adrenal adenoma as well as a pituitary adenoma. In 2009 I had two surgeries on my pituitary to remove the adenoma. When ACTH levels were not suppressed they did a bilateral adrenalectomy. I was doing great up until late this year. Pigment started getting really dark, fatigue has sat in to a great extent, stomach pain, diarrhea, vomiting on many of the days out of a week. Headaches have returned with some double and sometimes blurry vision. I am not losing weight again, and my mood swings are back, and I am very depressed. Endo did checks on my test and the first one was 496 at 9:00am and the second test he did was a suppression test, with levels only going down to 240 at 8:00am. I do not know what to demand at this point. I am once again feeling horrible and only know that as time goes on I will be worse. Can you please suggest a plan of action for me?

ANSWER: The elevated ACTH levels suggest that she may be developing Nelson's syndrome. This is a complication of the management of Cushing's disease (pituitary origin) with bilateral adrenalectomy. The remaining pituitary adenoma that was causing the Cushing’s, and was unsuccessfully resected, may now be growing and making larger amounts of ACTH than ever. If that is the diagnosis, it can be quite serious if not treated. The pituitary tumor may grow rapidly, causing compression of the remaining pituitary gland, leading to deficiencies of other pituitary hormones. The effect can be hypothyroidism, growth hormone deficiency, hypogonadism and sometimes diabetes insipidus. Also, if the tumor is large, it can compress the optic chiasm and cause loss of vision and headaches. The endocrinologist should evaluate all of these possibilities with lab tests, visual fields and a repeat pituitary MRI. If Nelson’s syndrome is diagnosed, therapy with medication (cabergoline and Sandostatin), radiation therapy or repeat pituitary surgery to remove the tumor can be successful. Appropriate replacement treatment for the surgical Addison's disease with hydrocortisone and fludrocortisone is essential. If hypopituitarism is present, replacement of the missing hormones is also a vital part of the management.



17) Q&A from the December, 2016 NADF newsletter:

QUESTION: I have Addison’s disease, and my doctor is trying me on a generic for Lyrica. It makes me very dizzy, so I am still on 1 instead of the gradual 4 he has prescribed. Has anyone else used this?

ANSWER: Lyrica is used primarily for painful neuropathy and can cause fatigue and dizziness. It is not prescribed for adrenal disease, but may be used as a part of pain management when there is a coincidental pain issue, especially neuropathy. Side effects must be discussed with the prescribing doctor and adjustments in the dosage may be required.



18) Q&A from the December, 2016 NADF newsletter:

QUESTION: Is it possible to have a low aldosterone level (close to the bottom of the scale) and low renin, but to have normal cortisol, electrolytes, and ACTH test? I suffer from low blood pressure. Can low aldosterone cause swelling of the submandibular salivary gland (the swelling is non-inflammatory, it is painless, bilateral and permanent), or abnormal fat distribution in the upper body? My lower body doesn't look swollen. And can low aldosterone somehow cause multiple aphtea/erosions/ulcers in the small intestine (that isn’t Crohn’s or Celiac disease)?

ANSWER: Hyporeninemic hypoaldosteronism is fairly common. It is caused by a defect in the kidneys. The signs are low blood pressure, a further drop in blood pressure on standing, and high potassium. In contrast to Addison's disease, people with this syndrome have normal levels of cortisol and ACTH. The treatment is replacement fludrocortisone (Florinef ) without the need for hydrocortisone. Many people with this syndrome have diabetes mellitus. Even if blood sugars are normal, the physical features of insulin resistance (the major cause of adult onset diabetes) include increased body fat in the middle of the body as well as swelling of the salivary glands. It would not generally include ulcers or changes in the small bowel.



19) Q&A from the December, 2018 NADF newsletter:

QUESTION: I’m a 47 year old man. I have congenital adrenal hyperplasia. I also have Pancreatitis. My question is can my medication of hydrocortisone steroids affect the lack of pain I feel. Could the pain be masked?

ANSWER: Replacement glucocorticoids will have no effect on pain. High doses may have an anti-inflammatory effect, but should not diminish your awareness of any activity of the pancreatitis.



20) Q&A from the March, 2019 NADF newsletter:

QUESTION: Can Conn’s turn into Addison’s? My husband had his left adrenal gland removed in March 2013, and now he is having symptoms of headache, high bloodpressure, and pain in his right side-adrenal area.

ANSWER: With high blood pressure at this point, there is a significant risk that hyperaldosteronism is still present. The remaining adrenal may be making excess aldosterone. A full repeat endocrine evaluation is needed. Addison’s disease is no t a consideration in this situation.



21) Q&A from the March, 2020 NADF newsletter:

QUESTION: I was diagnosed with Addison’s disease in 1988. I was wondering if anyone has tried CBD (cannabidiol) products to help with tiredness, joint pain, and muscle aches. If so, does it help, and are there any downsides to it? Thanks for any info you can give.

ANSWER: CBD products are now available without prescription because they contain no THC, the active cannabinoid in marijuana. Unfortunately, since the products are over the counter, manufacturers and distributers can make claims about benefits and purity that are unsubstantiated. We need controlled studies and better verification on the potency of these products. I am not an expert in the use of CBD oil or other products, but some of my patients without adrenal disease have reported short term help with anxiety and stress with the oil. I have no experience with CBD in Addison’s disease. I would express caution until there is more research and more consistency in the available products.



22) Q&A from the June, 2020 NADF newsletter:

QUESTION: Can people feel “real scientifically-proven adrenal pain” with primary or secondary adrenal insufficiency?

ANSWER: The adrenal glands do not have a lot of nerve endings. The only situation where adrenal pain may occur is when there is an acute hemorrhage into one or both adrenal glands due to a clotting disorder or from anticoagulants. This is a known but rare cause of primary adrenal insufficiency. With autoimmune primary adrenal insufficiency, the adrenal glands shrink slowly due to the chronic inflammation of the adrenal tissue, and that is painless. With secondary adrenal insufficiency, the lack of ACTH stimulation leads to a very slow shrinkage of the adrenal glands, which is also painless.



23) Q&A from the March, 2021 NADF newsletter:

QUESTION: I would appreciate any advice about adrenal insufficiency that is caused by opioid use, especially how it might affect treatment compared to other cases of AI.

ANSWER: Opioid-induced adrenal insufficiency is quite common. It has been estimated that between 9 to 29% of chronic opioid users develop some degree of adrenal insufficiency. The mechanism is suppression of the hypothalamic-pituitary responsiveness to the need for cortisol, so there is a relative deficiency of ACTH stimulation to the adrenals, resulting in inadequate cortisol production. This can produce a full spectrum of adrenal insufficiency symptoms, from negligible to full adrenal crisis if there is an acute precipitating illness or injury. The diagnosis is confirmed with a blunted cortisol stimulation test, but simply finding a low AM serum cortisol with a low ACTH level is sufficient. This is a form of secondary adrenal insufficiency, not Addison’s disease. The treatment is the same as other forms of secondary adrenal insufficiency: usually hydrocortisone, but prednisone would also work. There is no need for fludrocortisone. Some important notes: OIAD is more likely with higher doses of opioids and longer duration of usage. It is potentially reversible if opioids can be discontinued. Finally, since the need for replacement glucocorticoids will increase in times of stress, if pain is not controlled with the opioid use, a higher dose of glucocorticoids may be needed.



24) Q&A from the March, 2021 NADF newsletter:

QUESTION: My symptoms started 12 years ago but have gotten progressively worse over the last 3 years. Often, I find it hard to move and have to rest. I have a lot of symptoms such as fatigue, nausea, dizziness, 20-pound weight loss, vomiting, abdominal pain with no clear cause besides IBS, etc. I am on a high salt diet and have been prescribed a 0.05 mg dosage of fludrocortisone for a high heart rate due to POTS.

ANSWER: With the diagnosis of POTS and chronic fatigue syndrome, the symptoms are typical, including the GI symptoms. It is not possible to make an actual diagnosis, but it would be useful to get a 21-OH adrenal antibody test. If positive, that would suggest Addison’s and should be followed by an ACTH stimulation test to assess adrenal reserve. If it is negative, a further GI evaluation may reveal the cause of the symptoms.



25) Q&A from the June, 2021 NADF newsletter:

QUESTION: Should individuals with adrenal insufficiency stress dose prior to receiving the COVID-19 vaccine?

ANSWER: I do not advise using extra glucocorticoids on the day before or on the day of vaccination. I suggest the individual with adrenal insufficiency wait to see if significant side effects occur, usually the day after the vaccine. If there is fever, significant muscle aches and pains, and especially nausea or any typical adrenal insufficiency symptoms, I would then add stress dose steroids in addition to treating any fever with acetaminophen or ibuprofen. I have spoken to many of my patients about their experiences, and many report no side effects at all. Those that did have significant symptoms were individuals who had a history of acute Covid-19 infection earlier in the year, and then had the vaccine.



26) Q&A from the June, 2023 NADF newsletter:

QUESTION: I have had almost constant painless muscle twitching/Spasms on my upper abdomen where my stomach is. Does this have anything to do with Addison’s disease?

ANSWER: Addison's disease can cause muscle cramping, especially in the abdominal area. painless twitching is probably not related. It is worthwhile trying an extra dose of hydrocortisone at a time when the symptoms are worse to see if it subsides. If it doesn’t help, consider a neurology consultation.





Questions are normally submitted by NADF members.
Answers are from NADF's Medical Director Paul Margulies, M.D., FACE, FACP.

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