Adrenocorticotropin (ACTH) in Chronic Pain

To determine if severe, chronic, uncontrolled pain patients may alter their adrenocorticotropin (ACTH) serum levels. Fifty-five (55) severe, chronic pain patients who were failing standard medical treatment were tested for an ACTH serum level. Those patients with an abnormal (high or low) serum level were entered into an enhanced pain treatment program and retested in 90–120 days to help determine if pain treatment may normalize abnormal ACTH serum levels. Five (9.4%) patients had a high ACTH serum level, and ten (18.2%) patients had a low ACTH serum level. Of these 15 patients, 13 (86.7%) normalized their ACTH serum levels after 90–120 days of enhanced treatment. The remaining two patients were found to have organic hypopituitarism secondary to traumatic brain injury. Severe, chronic pain may alter serum ACTH levels, and enhanced treatment may normalize serum levels.