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2010-07-07 Forest Tennant MD DrPH Intractable Pain And Hormone Therapy

An Interview with Forest Tennant, MD, DrPH

July 7, 2010 by Kirkham R. Hamilton, PA-C
© copyright 2010, Prescription 2000, Inc.
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KIRK HAMILTON: Hi, my name is Kirk Hamilton, your host of Staying Healthy Today, and our mission is simple: To provide you credible usable health information from interviews and our educational resources to help you Stay and Be Well in the busy modern world.

Have you ever had really bad pain? Have you ever had it so bad that you know you just almost wish you would die? Well I've had herniated discs and I've been in bad pain for a couple of days but I can't imagine being in pain for weeks, months and years. And so that's something we're going to address today. Someone who has dealt with that on a very significant and large basis.

So today's show topic is "Intractable Pain And The Important Role Of Hormone Replacement." Our guest today is Dr. Forest Tennant, MD and Doctor of Public Health, owner and director of the Veract Intractable Pain Clinics in West Covina, California, and author of a recent article which caught my attention, and that's why we got back together again, "Hormone Replacement And Treatments In Chronic Pain" in the Journal of Practical Pain Management.

So I'd like to welcome Dr. Tennant onto the show today.

DR. FOREST TENNANT: Thank you, Kirk. Glad to be here.

KIRK HAMILTON: You have a handbook (The Intractable Pain Patient's Handbook for Survival) and I want to just read a paragraph out of it and maybe that will get us started. It says "No magic bullet. The worst propaganda being pushed upon all chronic pain patients, including those with and without intractable pain are the illusive "magic bullet" formulas being advanced by either pharmaceutical and medical device industries, unethical practitioners and some health plans and government agencies...The worst deception these days is the fraudulent pitch that pain can be cured by stopping all medications, as if control is the cause!!" And that's out of your little manual, so maybe we can get started from there. What is that statement trying to say in a nutshell?

DR. FOREST TENNANT: What that statement is trying to say is fundamentally some of the same things we've seen in such fields as weight control and that is that if you just try, you know this magic potion, you try this machine, you try this surgical procedure, you're going to be cured. And for millions of Americans that is a fraudulent statement. In other words when you have got nerve damage and it is not reparable by any known means today, at least for the vast majority of people who lets say have pain that lasts over 90 days.

KIRK HAMILTON: How do you define ‘regular pain' versus what you call ‘intractable pain,' the kind of patient that you see day in and day out?

DR. FOREST TENNANT: You can kind of divide pain into three simple categories. One is the one you just described where you have your bad disc or you take a fall, you've had your teeth pulled, you've had your appendix out, and these are what we would call the pain of an acute injury or an acute illness that's going to last a few days or a few weeks. And that pain, in fact most people who have pain, and all of us have been there for one reason or another, whether we've delivered a baby or you know had a fallen arch, our pain usually goes away after a week, ten days, three weeks, four weeks, something like that. Then you have a second category and that is people who have pain but it's intermittent. In other words we have millions of people who have a bad knee or a bad bunion or a TMJ, or a carpal tunnel or have headaches and they will experience pain on and off and it may last a lifetime, but it is on and off. It's intermittent if you want to call it that. And then you have a third category. Now the third category is the one that I have chosen to attempt to understand and to try to do something about because I found out many years ago there was literally no one in the country even interested in this problem, and that third category is the one we call ‘intractable.' And that is the person who has pain that is permanent. It is constant. It does not go away and it can be extremely disabling to the point that you're bed-bound or house-bound. And it is this latter group that has fundamentally had no scientific pursuit, has had no medical understanding, and in fact has fundamentally been a group of people in which everybody wants to deny exists.

KIRK HAMILTON: How many people in the United States have intractable pain?

DR. FOREST TENNANT: We know today that about ten million people have to take opioid drugs. Now not all of them would be intractable. Probably we would have, I'm going to guess somewhere between 1 and 3% of the population. Now that doesn't sound like a lot of people but when you stop and think that only about 1% of the population has insulin-dependent diabetes or schizophrenia or a heroin addiction, in other words, we have an awful lot of people who have this problem, and it would rank in prevalence right with severe hypertension or diabetes. And in other words there's a lot of people who do have this problem, and it can be mild, moderate and severe. But nevertheless these are patients who, and people will tell you they have pain 24 hours a day. The only time they don't have it is when they're asleep, and they usually have to take something to sleep, and in other words they have pain that doesn't ever go away.

KIRK HAMILTON: Let's get into the hormone issue because that's what kind of lit my curiosity up and we all know about corticosteroids, prednisone taken for different types of pain. But when you say hormones, describe when you got interested in hormones and pain, and is it because of a deficiency, or is it because you just need more hormones to deal with pain?

DR. FOREST TENNANT: Actually, all the things you said are true and we can get into that. But the real thing that caught my interest was many years ago I read two sets of papers. One, is articles by British physicians. The term "intractable" really comes from British physicians who had to give their World War II soldiers morphine. Then in the late 40s and 50s they coined the term intractable pain because they recognized these were injured soldiers who would have to take morphine the rest of their life. The second thing that caught my attention was a psychologist by the name of Chapman who many years ago wrote a theoretical article in the British journal The Lancet. And he came to believe that pain was fundamentally a huge stress and this stress would activate the pituitary gland and the adrenal gland and activate your adrenalin, noradrenaline, your cortisones and all of your adrenal hormones. And that after a while you might exhaust those, at which time you would become moribund, you would become apathetic, you would become depressed and that you functionally wouldn't have enough energy to even get out of bed. And he was even, though this was a theoretical idea, I believed he was correct. So I set out to do some scientific studies to prove whether he was correct or not and the moral of the story is, yes he was correct. And that is the terrible problem of people with intractable pain, is that they are going to activate their brain to electric charges that are stemmed from their injury. These electric charges in the brain are going to activate the pituitary gland which in turns activates your adrenal glands, your thyroid, either your ovary or testicle, and if the stimulus goes on long enough you exhaust your adrenal gland at which time you become you know quite disabled. That's when you don't have enough energy to get out of bed, you can't eat, you can't sleep, you can't think, you can't function, and that you become totally impaired and indeed if you don't get some help you probably will die.

KIRK HAMILTON: Well how about this then. If that stress continues not only do you exhaust those adrenal hormones for the fatigue part, but don't you have less anti-inflammatory hormones to deal with the pain so the pain gets worse?

DR. FOREST TENNANT: Absolutely. In other words, the body has about three immune systems. One is the one that you take an aspirin for or a Motrin for. You have what's called cytokines and leukotrienes. These are anti-inflammatory enzymes in all of our tissues. So that's step one. You have a second endocrine system - or immunologic system and that is your own natural endorphins. And the third one is that you have your own cortisone and your own adrenal hormones related to cortisone. And so you have three systems and the pain patient will exhaust those very fast if they don't get help for their pain.

KIRK HAMILTON: Can you explain the two phases? The Phase One, the Overstimulation, and then Phase Two, the Exhaustion. You kind of did but if you could clarify that for me.

DR. FOREST TENNANT: Yes. When I first started my investigations on this and started to understand it, I theorized as to, well now if pain is a stress just like when you're scared to death, you've been frightened, it's a fear response and that's where your blood pressure should go up and your pupils should dilate and you should start sweating and your pulse rate should go up because you are stimulating too much adrenalin to be produced in the body. And indeed that is true and adrenalin is just a hormone. And so that was the first thing I noticed did occur in patients who had severe pain. And of course ask any fifth grader who gets stung by a bee or stubs his toe, he knows his heart starts racing. So we actually have known this for a long time. We just put two and two together that this hypertension and this tachycardia or this fast heart rate was really due to the stress of pain. Now the second part of the adrenal gland is you have the adrenalin part and then you have the cortisone part if you will, and then your ovary and testicle and part of the adrenal glands makes your estrogen and your testosterone. So you've got these varied hormones and so pain activates all of them initially because these are all hormones that the body needs to heal itself. But if you can't heal and the pain persists, then pretty soon your pituitary gland in the brain and your hypothalamus and your adrenal glands and your testicle or ovary, which either one you possess, starts to deplete and exhaust. At which time this becomes a very serious medical condition. And in fact if you go back in history you will find out that people who had really severe pain didn't live very long. They just died.

KIRK HAMILTON: You know you said something interesting in the article that made me really stop and think and that's giving the medication, the pain medication - we're always thinking about trying to get people off pain medicine in general practice, but giving the pain medication is actually a thing you need to do for six to eight weeks I think you said, to stop the pain so therefore you stop your stress response to the pain, and then therefore there might be some type of healing that could go on. Am I saying that kind of correctly?

DR. FOREST TENNANT: Oh that's very correct. That's just right. Today we know that if you, let's say you have dental surgery, let's say you've delivered a baby and had a cesarean section, let's say you've slipped a disc, let's say that your hip has gone out of joint, or even a gunshot wound. I've had some recently, you know involvement again with the veterans. But at any rate, anything that causes you pain we now know that one wants to treat this very aggressively and keep the pain suppressed because if you do not, pain itself causes the whole nervous system and the pituitary system to change. And the reason it causes change is that pain is fundamentally electricity. Pain is nothing but electricity that accumulates where nerves are damaged because that's the whole function of a nerve, is to transmit electricity. So if you cut a wire the electricity just escapes. The trouble with the body is when you damage a nerve the electricity just accumulates all around the damaged nerve. And incidentally that's why such treatments as acupuncture, massage, Epsom salts, magnets, copper, all of these things have some place in trying to control pain because it controls electricity. But if you don't control the electricity, then you have all this hot wire or electricity going up into the brain and it will actually change the brain. And some of that change looks like we're not even certain how to get it back to normal. And that's why we're using hormone therapy to try to even change brain tissue, as well as tissues out in your spinal cord or in your knee or your hip that have been damaged.

KIRK HAMILTON: So that was an "ah-ha" for me that you actually - you need the pain medicine to stop that cycle. Now I wanted to get into the hormone part. What hormones do you assess? You know I know everybody gives cortisone in different ways for anti-inflammation. But what hormones like testosterone, pregnenolone, DHEA, what do you assess and how to you assess them in these chronic pain patients? And the adrenal gland, too?

DR. FOREST TENNANT: Yes. Today I think a physician who is in pain practice, if that's what he specializes in, and there's a lot of doctors coming into the field right now. Excellent physicians. In fact, it's a great movement that - American medicine these days doesn't have a lot to be proud of, but I think one of the things they can be proud of is that an awful lot of very fine physicians are coming into this field and they're getting it. They really are. But what one wants to do as a physician, and you talk to a patient and that patient says, "you know doctor that pain never goes away. I can't sleep, I can't eat, I can't go to work, I can't function. I'm spending all my time in bed. My family's gone, I can't work." When you get that history from that patient, what I recommend is that people at least take a simple blood test in the morning of testosterone, pregnenolone and cortisone. Now they - people have heard of cortisone, they've heard of testosterone; they don't know what pregnenolone is. But pregnenolone is actually the hormone that makes everything else. And it's a very important one to assess if one's attempting to try to deal with a severe pain patient.

KIRK HAMILTON: And you get these in the fasting state?

DR. FOREST TENNANT: It's usually done that way, yes.

KIRK HAMILTON: Do you just use the general lab values that your traditional lab has as low, medium and high, so to speak?

DR. FOREST TENNANT: Yes. Today throughout the country we have an excellent laboratory system in every town. In other words, every physician and every community in this country has access to excellent laboratory services and with a single blood tube this can be assessed. In other words, you can get an awfully good idea on this simple screening test if you - and tell whether your pituitary or your cortisone or your testicle or ovary is functioning correctly. And then, if they're not functioning correctly then you can go from there. And keep in mind when we say functioning correctly, you can have the adrenal gland and pituitary gland too overactive, or it can be too underactive. In other words, the body's hormone system functions in a range. We call it a normal range. It could either be underactive or you can be overactive, and either one will cause you harm and shorten your life, make you miserable and give you a list of complications a mile long.

KIRK HAMILTON: Let's say you were - I'm trying to get interested in kind of therapeutic dose ranges for hormone replacement for pain. Let's say you were low in testosterone, and I don't know what you define as low if you're - but let's say it's below 250 or 200 or whatever you define as low. What would you give as replacement dose? The same with pregnenolone and cortisol.

DR. FOREST TENNANT: Let's take testosterone. That's the easiest one to deal with because testosterone levels both in males and females are well known. And each laboratory may have a little bit of different piece of equipment that they measure with, and may give you a little different range but the laboratory will tell you that. And if you're low in testosterone and you happen to be a severe patient, you are going to need to take some testosterone, both males and females and the dosage - male dosage is standard also. They now have commercial products that make it easy for the doctor and the patient and the nurse in the sense that here it is. It's right on the package. Here's what you take.

KIRK HAMILTON: Do you use transdermal or injection?

DR. FOREST TENNANT: Both. In other words, standard creams that you put on are about - oh, they'll range about 50 mg a dosage a day, and then for females it would be about 10 or 20 mg a day. So these are pretty standard and they're easy for the physician to work with. In fact, our testosterone dosages are probably more standard than the others.

KIRK HAMILTON: How about pregnenolone, for example?

DR. FOREST TENNANT: Pregnenolone dosages are not as well known. It appears that - let's say a severe pain patient has a low pregnenolone. I recommend you start with 50 to 100 mg a day and then work up if need be. There is no upper dosage limit with pregnenolone. Pregnenolone incidentally is a fascinating compound. Some studies will say that it's the most plentiful hormone in the human brain. In other words, it may be made in the adrenal gland but it transports itself through the blood up to the brain. And it has all kinds of brain functions.

KIRK HAMILTON: Do you just use -

DR. FOREST TENNANT: It has all kinds of necessary functions to control pain. So whatever it takes to bring your pregnenolone level in the blood up to normal levels is what you take.

KIRK HAMILTON: Okay. And you don't mind if it's over-the-counter, or do you have it compounded, or -

DR. FOREST TENNANT: No. I mean that's the nice thing about pregnenolone. In other words, it's standard, it's been - it's amazing for such an important hormone in the body, you can buy it over-the-counter and the potency of those things I've found have been quite good. And I frankly have yet to see a complication of pregnenolone. It's an extremely safe thing to take, and it's very inexpensive and certainly anybody that might listen to this program and has severe pain, you could certainly better yourself and certainly at least try to protect yourself for a while by taking pregnenolone that you buy at any vitamin shop or a midi-level marketing or out of a catalog. There's a lot of great places to get it and if you take that, it will at least keep you alive and well until you can get some help.

KIRK HAMILTON: Well there's three more hormones that I want to get to, just a little overview, and that is cortisol, DHEA and you mentioned progesterone as well. And I've read about progesterone in pain and that would be one that most people don't even think about. So I was wondering if you could just go through those three and comment on them.

DR. FOREST TENNANT: First off, the hormone most people have heard about is cortisone. And in fact, a lot of people don't even - they've heard about it so often they don't even realize that it is a natural adrenal gland hormone. And they hear horror stories about - it's called a glucosteroid and so they've heard of anabolic steroids so they think it's bad automatically. They also have seen people who have taken cortisone shots in the knee or in the spine and gotten some complications. They know of people who have taken too much cortisone and gotten complications and all of these things indeed have happened, but if you don't have enough cortisone or if your body is making too much cortisone, you are going to have your life shortened, you're going to suffer, you're going to be miserable, you're going to have a lot of complications and your pain is not going to be controlled. Fortunately, cortisone levels in the blood are the easiest to control. One just simply needs to get some pain relief through something simple - it might be as simple as taking some Vicodin or some Percocet or something like that, and it will control the blood level of the cortisol. The adrenal gland is very flexible and will produce the normal levels, not too high and not too low, if you just give it some pain relief. So the cortisone is actually one of the easier ones to deal with.

KIRK HAMILTON: And what doses would you use in that?

DR. FOREST TENNANT: You rarely have to replace cortisone in pain patients. There, if you just control the pain, the cortisol turns to normal in 95% of the cases.

KIRK HAMILTON: Whether it's high or low?

DR. FOREST TENNANT: Whether it's high or low. And it does that within about six weeks of pain treatment. Now if you have to take some cortisone, different doctors will use different cortisone formulations. The most common one is probably hydrocortisone itself, known as a bioidentical hormone. And the dosage on that range is anywhere from 10 to 20 mg a day. A lot of doctors like to use a synthetic called prednisone and that dosage is about 5 or 10 mg a day. And then you have some of the more high potency ones that some of your endocrinologists like to use and they're also very effective. So cortisone is actually one of the - for a physician who specializes in it, it's quite easy for us to deal with.

KIRK HAMILTON: Well there's two other ones that actually people can get over-the-counter and that's DHEA, an adrenal hormone, and progesterone, now you can get as a cream over-the-counter, and so how do you use those?

DR. FOREST TENNANT: Okay. Let's take DHEA first off. DHEA is a precursor to both cortisone and to testosterone and estrogen. So if a patient has to take any one of those, if he takes a supplement of DHEA which you can get over the counter at a dose of around 50 or 100 mg you can boost your own cortisone, your own estrogen or your own testosterone. And I highly recommend it. Again, I know of - I mean I can't even give you a number of all the patients I've personally given DHEA to, and I've never seen a complication. So it's very safe, very inexpensive and I highly recommend it. The progesterone that one gets over-the-counter, usually called Pro-Gest®, it will be one of those names and it will be an extract from one of the yams. That is probably not going to be potent enough to help too much with pain. One is going to have to get a more potent compound of that. It doesn't hurt anybody but what you get over-the-counter with progesterone in my experience is not potent enough.

KIRK HAMILTON: If you're going to get a higher dose, would you use a cream or a pill compounded?

DR. FOREST TENNANT: What I have done in recent times - there is a synthetic progesterone known as medroxyprogesterone, spelled m-e-d-r-o-x-y-p-r-o-g-e-s-t-e-r-o-n-e. It comes in a 10 mg tablet. It's very inexpensive. Your doctor can get this. We will make a cream out of this as well as you can take it orally. We have seen some males come off their testosterone if they can take the progesterone or they cut it way down because progesterone is a precursor of testosterone and of estrogen. You can make a cream out of it and as a matter of fact I have found that progesterone cream, the medroxyprogesterone cream, when it's applied over a pain site, bad knee, bad back, bad shoulder, somewhere like that, that you get tremendous relief particularly if you can use it under an infrared or a vibrator or a TENS unit or something like that. We call that ionophoresis, but progesterone topical and oral is "the new kid on the block." We don't know quite as much about it as we would like, but I can tell you that in pain treatment it's proven to be a god-send. I'm getting some results I'm just so happy about because it really does seem to be very effective in many situations.

KIRK HAMILTON: So you're pretty much using medroxyprogesterone. Orally are you using 10, 20 mg or -

DR. FOREST TENNANT: Yeah.

KIRK HAMILTON: Alright. That's your dose, 10-20 mg range.

DR. FOREST TENNANT: In other words, if a male or female has to take testosterone for example, they can use the precursor's pregnenolone, DHEA, or progesterone and they can get an added effect of their hormone replacement and added pain relief.

KIRK HAMILTON: Well I'd like to finish up. I could go on all day, but I've got a couple of things I wanted to ask you.

DR. FOREST TENNANT: Sure.

KIRK HAMILTON: I know this is about hormones, but do you have any special dietary recommendations for your chronic pain patients like eat more fish?

DR. FOREST TENNANT: Yes I do.

KIRK HAMILTON: Get off dairy products, or I don't know, whatever you do?

DR. FOREST TENNANT: Yes I do. Severe pain patients need to be on a high protein diet. They have to forget low cholesterol diets, low carbohydrate, I mean high carbohydrate diets for diabetes or something like this. They need their own special diet. And I recommend a diet of at least 50% protein. Now why protein? Protein is comprised of amino acids. Everything that we've been talking about today pretty well derives from amino acid. For example, your natural endorphins are derived from amino acids. Something called gamma-amino-butyric acid (GABA) is derived from amino acids. Dopamine does, adrenaline does, and so these things that a pain patient needs are derived from protein. And unfortunately severe pain lowers blood sugars. If you have to take an opioid drug that also lowers blood sugar so these people even have more than the average carbohydrate which is sugar and starch cravings than the rest of us. And the rest of us have that bad enough. So it's difficult, but that's what they need. They need you know, they need bacon and eggs in the morning, they need tuna salad at lunch, and they need beef, pork, ham or fish at night. In other words they need a high protein diet.

KIRK HAMILTON: So let me ask you a question. So they've taken rheumatoid arthritics and fasted them and this is in The Lancet, and then put them on vegan diets that are low in allergy and they have dramatic reduction in pain. That's an inflammatory pain which is different than the intractable pain. Is that what...

DR. FOREST TENNANT: Yes. Now, you have two kinds of rheumatoid arthritics. Most of them are fairly intermittent pain. Very common. So most arthritics would not be considered intractable.

KIRK HAMILTON: Right.

DR. FOREST TENNANT: Now if they are intractable, they're going to have to take opioid drugs and they're going to have hormone replacements as well as their standard you know rheumatoid arthritis drugs. But most rheumatoid arthritics are intermittent pain. They can do well on a vegan diet or pretty well whatever diet they want to be on. A good weight reducing diet would be quite good. But again, we go back to the definition of what intractable pain is. Intractable pain is that severe pain that is there 24 hours a day. It never goes away. You can't sleep, you can't eat, you can't think, you're bed-bound, you're suffering. That is not the case with the vast, vast majority of rheumatoid arthritis patients.

KIRK HAMILTON: Okay. How about dietary supplements to kind of wrap this up. What do you recommend, if any?

DR. FOREST TENNANT: Again, the dietary supplements that I think that pain patients, whether intractable or not, I would have to put the number one dietary supplement to take, other than a vitamin, a good vitamin and mineral preparation. That should be standard for everybody who's got pain. A good vitamin and mineral preparation is absolutely essential. But the other one, and also the second one is one needs to be taking a osteoporosis prevention compound, something with calcium and magnesium and vitamin D in it. So those would be the two basic dietary supplements that every pain patient needs to take. The calcium, magnesium, vitamin D preparation as well as a good vitamin and mineral preparation each day. So that's just standard. But above and beyond that, the supplements that I would take would be either taurine - I would take taurine or glutamine or pure gamma-aminobutyric acid (GABA) and those would be the other things. And then the fourth one if I had to pick one, I'd pick pregnenolone.

KIRK HAMILTON: So how does it, that taurine, the glutamine and the GABA help with pain again?

DR. FOREST TENNANT: We haven't really talked about it, but there is another hormone in the body known as gamma-aminobutyric acid (GABA) and that is the hormone that is in the nerves between the - in all the nerve junctions both in the brain, the spinal cord as well as out in your arm and legs. And so you've got to have a lot of gamma amino butyric acid to have good pain control. And you can actually - it's a little hard, but you can actually buy gamma-aminobutyric acid in the health food store, but it's not very effective unless you chew it and have it absorbed under the tongue. You really can't swallow it very well and have it be very effective. But that's another hormone we didn't talk much about but it's essential and one that pain patients need.

KIRK HAMILTON: Do you ever measure vitamin D levels?

DR. FOREST TENNANT: Yes, uh-huh.

KIRK HAMILTON: And do you see them low in chronic pain?

DR. FOREST TENNANT: Yes, they're almost uniformly low. That's the reason why I recommend you know people take it.

KIRK HAMILTON: We've got to wrap this up now, but how, if someone was in chronic pain, how do they find a good pain specialist? How do they do that?

DR. FOREST TENNANT: What you, what they want to do is ask around for a pain specialist that does not do nerve blocks. In other words, you have two kinds of pain doctors - those that do the nerve blocks and they do injections. They like to refer to themselves as interventionalists, and they spend a good part of their time you know giving people epidural shots, other injections, implanting devices, and they have to be very skilled to do that, but that skill ability takes them out of trying to manage things well medically or nutritionally or hormonally. And so you want to just ask around. What is a good pain doctor who deals with hormones and supplements? But I would particularly ask about the hormones. Okay?

KIRK HAMILTON: That's pretty much going to be the standard fare for -

DR. FOREST TENNANT: That's gonna be the future, and Kirk if we have 30 seconds, I do want to tell you, mention a name so at least your listeners have heard it.

KIRK HAMILTON: Go for it.

DR. FOREST TENNANT: Human chorionic gonadotrophin. Better known as HCG. That has something about it that looks like maybe the hormonal treatment that will reverse some of the brain damage and some of the nerve damage that's being done. It's got curative effects.

KIRK HAMILTON: Do you give it by injection or how do you do that?

DR. FOREST TENNANT: It can be taken by injection or some of your compounding pharmacies are now making it as a nasal compound, but anyway you're going to hear a lot about that. You know for example it had some publicity last year when it was found that Manny Ramirez with all his hormones was taking HCG. And it does cause you know growth of muscle, shrinkage of fat, a lot of people have used it for weight control, but there's some things about it, that as to what it is that has some very special characteristics. For example HCG activates all the hormones in the body, testosterone, estrogen, cortisone, thyroid, but it also has some other effects in the brain. And I point this out because it's got kind of a - nobody knows much about it, but it will be something you will hear about it. It is related to growth hormone itself and - but growth hormone doesn't help pain too terribly much because it's pretty much you know a cartilage and bone grower and the real problem with pain is you've got damaged nerves. It's a soft tissue situation. But I want to point that out in that's a big area of my own research right now.

KIRK HAMILTON: What's the number for your clinic? The Veract Intractable Pain Clinic, the main number in Southern California in West Covina.

DR. FOREST TENNANT: 626-919-0064.

KIRK HAMILTON: I imagine you have a few people come from far and wide?

DR. FOREST TENNANT: Yes, we're here in California, but we have people come as far away as Maine, Florida, so we've started to have people come from all over the country into Southern California because they want the very best and if they can afford the flight, what have you, that's what they're starting to do. I personally am on the road a lot teaching and trying to you know publish research and talk to people like you who can spread the word because it certainly does need to be spread because it is a real hope for people.

KIRK HAMILTON: Dr. Tennant, thanks so much. It's been great to reconnect.

DR. FOREST TENNANT: You bet.

KIRK HAMILTON: And we'll talk soon.

DR. FOREST TENNANT: Alright, Kirk, it's been great talking to you. Good luck.

KIRK HAMILTON: Thank you very much.

And in closing, I want to thank the audience for listening today to this edition of Staying Health Today Radio. And until next time, Stay and Be Well.

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