Methods for treating chronic or unresolvable pain and/or increasing the pain threshold in a subject and pharmaceutical compositions for use therein
Methods are provided for reducing chronic inflammatory pain, increasing the levels of endogenous opioid peptides, as well as increasing the pain threshold of a subject having symptoms of androgen deficiency, comprising transdermally administering a composition comprising a bioactive androgen on a daily basis. In addition, the invention also relates to increasing the levels of endogenous opioid peptides in a human subject by administering an androgen composition to the subject. The invention also encompasses administration of a composition consisting essentially of an androgen for the treatment of chronic inflammatory pain, and for increasing the pain-threshold in a subject.
1. A method of reducing chronic inflammatory pain in a human testosterone-deficient subject in need thereof, comprising:
administering a composition to the subject, said composition comprising a pain-reducing amount of testosterone in the absence of exogenous opiates,
wherein the subject has testosterone levels in the lower half of the appropriate reference range, and
the method reduces chronic inflammatory pain in the human testosterone-deficient subject in need thereof.
2. The method of claim 1 , wherein the subject's testosterone serum levels are restored from the baseline to the middle to upper range of an appropriate reference range.
3. The method of claim 1 , wherein the subject further suffers from at least one androgen-deficiency symptom selected from the group consisting of: elevated C-reactive protein; elevated erythrocyte sedimentation rate; and an unresolvable stressor state.
4. The method of claim 3 , wherein the unresolvable stressor state is selected from the group consisting of post-traumatic stress disorder (PTSD), accident, trauma, surgery, autoimmune disease, chronic unresolved or acute viral infection, infectious disease, cancer, chronic exhaustion or physical distress, neuropathy, hyperalgesia, allodynia, grief, emotional distress, depression, dysthymia, surgical gonadectomy, pharmacologic-induced gonadectomy, DSM-IV disorder 307.80, and DSM-IV disorder 307.89.
5. The method of claim 1 , wherein the composition is administered in combination with an antidepressant selected from the group consisting of a tricyclic antidepressant, a serotonin-norepinephrine reuptake inhibitor (SNRI), and a selective serotonin reuptake inhibitor (SSRI).
6. The method of claim 1 , wherein the composition is administered to deliver a daily unit dose of about 1.0 mg to about 12.8 mg of the testosterone to a female human subject, wherein the administration results in steady state total testosterone serum levels without raising free testosterone serum levels or twenty-four hour free testosterone AUC above the levels required for therapeutic efficacy and safety, wherein the administration is selected from the group consisting of transdermal administration, oral administration, parenteral administration, intramuscular administration, and buccal administration.
7. The method of claim 6 , wherein the composition is formulated as a gel for transdermal administration, wherein the gel comprises the testosterone and a pharmaceutically acceptable carrier.
8. The method of claim 6 , wherein the daily unit dose of the testosterone is selected to maintain steady state total testosterone serum levels within a range of between about 0.9 ng/mL to about 1.4 ng/mL within 24 hours after administration.
9. The method of claim 6 , wherein the free testosterone serum levels are raised to about 1.00 pg/mL to about 3.30 pg/mL and the twenty-four hour free testosterone AUC levels are raised to about 40 pg-h/mL to about 65 pg-h/mL.
10. The method of claim 1 , wherein the composition is administered to deliver a daily unit dose of about 35 mg to about 100 mg of testosterone to a male human subject, wherein the administration results in steady state total testosterone serum levels without raising free testosterone serum levels or twenty-four hour free testosterone AUC above the levels required for therapeutic efficacy and safety, wherein the administration is selected from the group consisting of transdermal administration, oral administration, parenteral administration, intramuscular administration, and buccal administration.
11. The method of claim 10 , wherein the daily unit dose of the androgen is selected to maintain steady state total androgen serum levels within a range of between about 2.4 ng/mL to about 9.5 ng/mL within 24 hours after administration.
12. The method of claim 10 , wherein the free androgen serum levels are raised to about 90 pg/mL to about 300 pg/mL and the twenty-four hour free androgen AUC levels are raised to about 350 pg-h/mL to about 800 pg-h/mL.
13. The method of claim 1 , wherein the composition consists essentially of the testosterone and at least one pharmaceutically acceptable carrier.
14. The method of claim 1 , wherein the human subject is endogenous opioid peptide-deficient and the composition increases endogenous opioid peptide production in the human subject.
15. The method of claim 14 , wherein the opioid peptides are selected from the group consisting of enkephalins, endorphins, dynorphins, adrenorphin, amidorphin, and opiorphin.
16. The method of claim 14 , wherein the endogenous opioid peptide levels are measured in cerebrospinal fluid.
17. A method of increasing the pain threshold in a human testosterone-deficient subject in need thereof, comprising
administering a composition to the subject, said composition comprising a pain-threshold increasing amount of a testosterone in the absence of exogenous opiates,
wherein the subject has testosterone levels in the lower half of the appropriate reference range, and the method increases the subject's pain-threshold.
18. The method of claim 17 , wherein the subject's testosterone serum levels are restored from the baseline to the middle to upper range of an appropriate reference range.
19. The method of claim 17 , wherein the subject further suffers from at least one androgen-deficiency symptom selected from the group consisting of: elevated C-reactive protein; elevated erythrocyte sedimentation rate; and an unresolvable stressor state.
20. The method of claim 19 , wherein the unresolvable stressor state is selected from the group consisting of post-traumatic stress disorder (PTSD), accident, trauma, surgery, autoimmune disease, chronic unresolved or acute viral infection, infectious disease, cancer, chronic exhaustion or physical distress, neuropathy, hyperalgesia, allodynia, grief, emotional distress, depression, dysthymia, surgical gonadectomy, pharmacologic-induced gonadectomy, DSM-IV disorder 307.80, and DSM-IV disorder 307.89.
21. The method of claim 17 , wherein the composition is administered in combination with an antidepressant selected from the group consisting of a tricyclic antidepressant, a serotonin-norepinephrine reuptake inhibitor (SNRI), and a selective serotonin reuptake inhibitor (SSRI).
22. The method of claim 17 , wherein the composition is administered to deliver a daily unit dose of about 1.0 mg to about 12.8 mg of the testosterone to a female human subject, wherein the administration results in steady state total testosterone serum levels without raising free testosterone serum levels or twenty-four hour free testosterone AUC above the levels required for therapeutic efficacy and safety, wherein the administration is selected from the group consisting of transdermal administration, oral administration, parenteral administration, intramuscular administration, and buccal administration.
23. The method of claim 22 , wherein the composition is formulated as a gel for transdermal administration, wherein the gel comprises the testosterone and a pharmaceutically acceptable carrier.
24. The method of claim 22 , wherein the daily unit dose of the testosterone is selected to maintain steady state total testosterone serum levels within a range of between about 0.9 ng/mL to about 1.4 ng/mL within 24 hours after administration.
25. The method of claim 22 , wherein the free testosterone serum levels are raised to about 1.00 pg/mL to about 3.30 pg/mL and the twenty-four hour free testosterone AUC levels are raised to about 40 pg-h/mL to about 65 pg-h/mL.
26. The method of claim 17 , wherein the composition is administered to deliver a daily unit dose of about 35 mg to about 100 mg of testosterone to a male human subject, wherein the administration results in steady state total testosterone serum levels without raising free testosterone serum levels or twenty-four hour free testosterone AUC above the levels required for therapeutic efficacy and safety, wherein the administration is selected from the group consisting of transdermal administration, oral administration, parenteral administration, intramuscular administration, and buccal administration.
27. The method of claim 26 , wherein the daily unit dose of the androgen is selected to maintain steady state total androgen serum levels within a range of between about 2.4 ng/mL to about 9.5 ng/mL within 24 hours after administration.
28. The method of claim 26 , wherein the free androgen serum levels are raised to about 90 pg/mL to about 300 pg/mL and the twenty-four hour free androgen AUC levels are raised to about 350 pg-h/mL to about 800 pg-h/mL.
29. The method of claim 17 , wherein the composition consists essentially of the testosterone and at least one pharmaceutically acceptable carrier.