Hey everyone. I wanted to post some articles I've found. I've had moderate adrenal symptoms over the last 15 years, which I'd maintained through diet and lifestyle choices (no meds then). I do have major spinal cord injury and did undergo radiation 2.5 years ago. During radiation I was on a large steroid dose and felt "normal". After pulling the steroid dose, I did not do well. The adrenal symptoms largely imitated spine damage, so I did not understand fully what was going on in my body. It cost me a lot of time spent on pain management instead of adrenal support. My nerve pain perception normalizes when cortisol is normal and it seems to amplify as cortisol drops. The worse my adrenals are, the harder it is to deal with pain. I dealt with pain using ibuprofen post surgery, but at the radiation damage began to heal my nerve pain went through the roof. I eventually went to opiates. Tramadol is a biggie for people with permanent nerve issues. I tried other things as well, I ran through all the different options. I noticed every time I'd try an increase in opiate dose the adrenal symptoms got worse. At one point my bp was 90/40, so I started to pull myself off the opiates. I had no idea my issues were adrenal, so I didn't know what to look for. When I started Tramadol, I did feel better initially. I honestly would not say I was ever on a large dose of pain meds, 150 mg Tramadol daily at highest. At any rate, if you have adrenal issues and you take pain medications I am just posting a word of extreme caution. Find a good doctor you trust with your adrenal issues, get regular tests. I don't think it's common knowledge that opiates can cause HPA dysfunction, it's something you have to dig for. Opiates should not be dropped cold turkey. I don't like to be presumptive. However, I wish someone had relayed this info to me 2 years ago. So I feel an obligation to pass it along. Articles: Adrenal insufficiency in acute oral opiate therapy: https://www.edmcasereports.com/arti...d-metabolism-case-reports/10.1530/EDM-13-0071 Altered HPA Axis Responsivity in Heavy Opiates (Cocaine): http://www.nature.com/npp/journal/v24/n5/full/1395630a.html (I realize people aren't taking cocaine for nerve pain but the HPA information seems somewhat relevant in any case). Tramadol Induced Adrenal Insufficiency: http://hal.archives-ouvertes.fr/docs/00/66/08/93/PDF/PEER_stage2_10.1007%2Fs00228-011-0992-9.pdf Cortisol Screening in Pain Patients: http://www.practicalpainmanagement.com/pain/cortisol-screening-chronic-pain-patients Looking at it from a pain management side. This advocates using opiates to keep cortisol levels from consistently rising and causing adrenal problems: "Patients on opioids who complain of poor pain control also should be screened, because adrenal corticoids are necessary for opioid receptor binding and maintenance of the blood–brain barrier." Search terms: HPA axis, opiates, adrenal, adrenal insufficiency. There are some further notes on PUBMED. If you dig you can find some different articles. I'm not going to say I know whether or not it's best to abstain from opiates, we live in a gray world. Nothing is black or white. You just need to find what works best to survive. I think with certain types of pain, it's possible that opiates might work in your favor. I know in my case, with Tramadol, it created a severe HPA disregulation and each time I take opiates my symptoms seem worse instead of better. I think the take home is that if you are on opiates, you do need to be carefully monitoring your adrenals if you have adrenal problems. So, I'm still not done studying the issue yet, but I think it's worth an open dialog. Best wishes.