This week I’m sharing my notes from the presentation by renowned pain management specialist Forrest Tennant, MD at the 2013 Women in Pain conference on September 13th.

Dr. Forest Tennant, MDDr. Tennant offered this audience of regular folks (most living with pain) the same presentation he gave the week before to a room full of physicians, “The Critical Importance of How Pain will Centralize.”

He spoke of two pain-related scientific breakthroughs in the last decade. First, the realization that pain can and will centralize in the spine/brain from the periphery. And second that hormones are connected to pain, and can be used for virogenensis (the ability to regrow nerves) and pain management.

Central pain is pain that is driven by a focus inside the brain and characterized by constancy and hyperarousal of the autonomic nervous and endrocrine systems. It can begin in three different ways: brain injury, peripheral nerve injury and from other types of pain (such as autoimmunity, fibro, vulvodynia, interstitial cystitis).

Central pain will be essentially constant. With central pain, the patient will have poor or zero response to peripheral treatments. Patients are also likely to have insomnia! Along with these signs, the manifestations include depression, fatigue, anorexia and functional paralysis (bed or couch bound).

Centralized pain can happen as quickly as 2 hours after an injury or other pain-related event, and is definitely likely to occur if pain is unresolved after 6 weeks. It can be delayed, and then feel as if the pain as “suddenly taken over.”

While diagnosis depends mostly on history and physical exam, lab tests (especially early on) can confirm and support. According to Dr. Tennant, we are still learning how hormone (ACTH, cortisol, pregnenolone, DHEA, testosterone) levels can help in this process, in addition to inflammatory markers.

Because central pain includes changes in brain tissue and function, some of the simple yet critical things to treat it are nutrition & exercise. It’s also super important for patients to start working out their brain—first key steps there are reading and socialization.

One of the primary elements for healing to occur is oxygen—even just doing deep breathing or receiving massage! Other options are walking, bouncing on a rebounder or trampoline, and talking. You’ll want to generate a little stress but not too much.

What does Dr. Tennant recommend eating if you are experiencing central pain? Getting enough protein is essential—a high protein diet (whether animal, vegetarian or vegan) is best. What you gain with high protein is lots of amino acids—and these are what make endorphins, glutamine, and neurotransmitters work.

You also want to be aware that experiencing pain will drive down blood sugar – and that’s why people in pain find themselves craving sugar or carbs. More high protein will help balance this blood sugar issue.

Plus it’s super important to get plenty of green veggies for their anti-inflammatory and antioxidant benefits!

Dr. Tennant recommended these supplements: Fish oil at up to 4000 milligrams/day, vitamin B12, and folic acid. (These both work to make the lining of nerves work properly.) You also want to consider taking a vitamin-mineral preparation of GABA or its precursors taurine and glutamine.

The medical treatment options Dr. Tennant discussed include the options you would normally think of like opioids, anti-inflammatory and neuropathic agents, plus sedatives and antidepressants. But, he also described a new focus on the hormones HCG and oxytocin. HCG will stimulate growth in nerve tissues, hair and skin tissues. It also seems to reduce intractable pain. Plus studies are now showing that oxytocin is the body’s major internal pain reliever, rather than endorphins. He is giving patients both HCG and oxytocin together now too.

You can read more by downloading Dr. Tennant’s patient-centered pain handbooks at

Again, I am so grateful for the opportunity to hear this information at the Women in Pain conference. I hope that my sharing it has been helpful to you!


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