Recombinant human growth hormone improves cognitive capacity in a pain patient exposed to chronic opioids.
During recent decades, the increasing use of opioids for chronic non-cancer pain has raised concerns regarding tolerance, addiction, and importantly cognitive dysfunction. Current research suggests that the somatotrophic axis could play an important role in cognitive function. Administration of growth hormone (GH) to GH-deficient humans and experimental animals has been shown to result in significant improvements in cognitive capacity. In this report, a patient with cognitive disabilities resulting from chronic treatment with opioids for neuropathic pain received recombinant human growth hormone (rhGH) replacement therapy. A 61-year-old man presented with severe cognitive dysfunction after long-term methadone treatment for intercostal neuralgia and was diagnosed with GH insufficiency by GH releasing hormone-arginine testing. The effect of rhGH replacement therapy on his cognitive capacity and quality of life was investigated. The hippocampal volume was measured using magnetic resonance imaging, and the ratios of the major metabolites were calculated using proton magnetic resonance spectroscopy. Cognitive testing revealed significant improvements in visuospatial cognitive function after rhGH. The hippocampal volume remained unchanged. In the right hippocampus, the N-acetylaspartate/creatine ratio (reflecting nerve cell function) was initially low but increased significantly during rhGH treatment, as did subjective cognitive, physical and emotional functioning. This case report indicates that rhGH replacement therapy could improve cognitive behaviour and well-being, as well as hippocampal metabolism and functioning in opioid-treated patients with chronic pain. The idea that GH could affect brain function and repair disabilities induced by long-term exposure to opioid analgesia is supported.
Department of Surgical Sciences, Anaesthesia/Pain Research, Uppsala University, Uppsala, Sweden.
A
A
Rhodin
M
M
von Ehren
B
B
Skottheim
A
A
Grönbladh
F
F
Ortiz-Nieto
R
R
Raininko
T
T
Gordh
F
F
Nyberg
D017209:Apoptosis / Q000187:drug effects; D001120:Arginine; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D003072:Cognition Disorders / Q000139:chemically induced / Q000188:drug therapy*; D003401:Creatine / Q000032:analysis; D013006:Growth Hormone / Q000627:therapeutic use*; D013007:Growth Hormone-Releasing Hormone; D006624:Hippocampus / Q000737:chemistry / Q000187:drug effects / Q000473:pathology; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency / Q000378:metabolism; D006801:Humans; D007431:Intraoperative Complications / Q000188:drug therapy / Q000209:etiology; D007668:Kidney / Q000601:surgery; D008297:Male; D008691:Methadone / Q000009:adverse effects*; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects*; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D055495:Neurogenesis / Q000187:drug effects; D059348:Peripheral Nerve Injuries / Q000188:drug therapy; D066244:Proton Magnetic Resonance Spectroscopy; D011788:Quality of Life
D009294:Narcotics; D019382:Human Growth Hormone; D001224:Aspartic Acid; D013006:Growth Hormone; D013007:Growth Hormone-Releasing Hormone; D001120:Arginine; C000179:N-acetylaspartate; D003401:Creatine; D008691:Methadone