Hypogonadism in Patients Treated With Intrathecal Morphine

Finch, Philip M.; Roberts, Lindy J.; Price, Leanne; Hadlow, Narelle; Pullan, P. T.

doi:10.1097/00002508-200009000-00011

Cited by 119 publications

(93 citation statements)

References 14 publications

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“…This is strongly supported by the significant correlation between the VAS scores of pain intensity and severity of SD found in the present study. Another potential contributor to interference with normal sexual function is the use of medications such as antidepressants [21,22] and opioids [18,19,20,33]. In the present study, all four classes of medications (non-opioids, opioids, antidepressants and anticonvulsants) had been used in significantly higher percentages of patients with SD than by those who did not report SD.…”

Section: Discussionmentioning

confidence: 47%

“…A higher prevalence of SD was reported in patients with chronic pain who had greater disability and depression, shorter pain duration, and infrequent use of coping self-statements. Adverse effects of medications, which are used frequently for the management of chronic pain, can also alter sexual function [18][19][20][21][22]. The present study was aimed to validate previous published knowledge on this topic by conducting a survey on the prevalence and severity of painrelated SD in a large population of patients with chronic pain who were referred to a tertiary ambulatory care pain clinic in Israel.…”

Section: Introductionmentioning

confidence: 98%

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Sexual Dysfunction in Patients with Chronic Pain

Gruenwald¹

2017

UNOAJ

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Objective: Restricted normal activities associated with chronic pain are well documented. In contrast, there is a paucity of reports regarding the association between chronic pain patients and their sexual function. The aim of the present "snapshot" study was to evaluate the prevalence and severity of sexual dysfunction (SD) in a cohort of patients suffering from chronic pain.Methods: 709 patients with chronic pain completed questionnaires assessing demographics, pain-intensity, disability and severity of their SD. A subgroup also completed questionnaires relating to depression and anxiety as well as specific gender-related SD questionnaires.Results: 404 patients (58%) reported pain related SD. No differences in demographic parameters were found between those with and without SD. In contrast, patients with SD exhibited significantly higher scores in pain intensity (VAS), Short-form McGill Pain questionnaire and the Oswestry Disability Index. Patients with SD also consumed significantly higher doses of pain medications. On both numerical and categorical self-report scales of SD severity, women scored slightly but significantly higher than men. A significant correlation was found between pain intensity and SD severity (Pearson's test: r=0.349; p<0.001). The questionnaires completed by a sub-group of patients with SD revealed a mild degree of depression, a moderate anxiety level and a moderate degree of SD in both genders. Conclusion:A significant number of patients with chronic pain suffer from moderate to severe SD, which correlates with pain intensity. These findings are congruent with previous reports and highlight the importance of increased awareness to SD in patients with chronic pain.

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Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 98%

Sexual Dysfunction in Patients with Chronic Pain

Gruenwald¹

2017

UNOAJ

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“…Opioids have been shown to decrease sex steroid levels in both men and women [22,[204][205][206][207][208]. The effect may be medicated by suppression of gonadotropins by opioids, and the effect is reversible by opioid antagonists such as naloxone [22].…”

Section: Pain Medicationmentioning

confidence: 99%

Adverse Effects of Drugs on Bone and Calcium Metabolism/Physiology

Vestergaard

2007

Clinic Rev Bone Miner Metab

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Drugs may affect bone turnover and density in many ways. However, the disease for which the drugs are administered may also contribute to bone loss. Infection with human immunodeficiency virus leads to a loss of bone mineral, while treatment with highly active antiretroviral therapy does not seem to contribute to further bone loss. Type 1 diabetes is associated with a decrease in bone mineral, while type 2 diabetes is associated with an increase. The new class of thiazolidinediones (glitazones) has been associated with an increased loss of bone mineral. In breast cancer treatment, tamoxifen is associated with an increased bone mineral, while the newer class of aromatase inhibitors through a decrease in serum oestradiol are associated with an increased loss of bone mineral. Strong analgesics (opioids) may decrease bone mineral density through inhibition of gonadotrophins while weak analgesics such as the non-steroidal anti-inflammatory drugs may increase bone mineral through an effect on the prostaglandin system. However, possibly through an increased risk of falls, the weak analgesics are associated with an increased risk of fractures. Proton pump inhibitors may lead to a decreased calcium absorption and thus a decreased bone mineral and an increased risk of fractures.

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“…Recent reports indicate that intrathecal [53][54][55] and oral [56] opioid therapy produce significant reductions of testosterone levels in men on opioid therapy, apparently due to central suppression of gonadotropin-releasing hormone production. Because hypogonadism can manifest itself in various ways, such as decreased libido, depression, loss of muscle strength and mass, and decreased hair growth, clinicians must have a high index of suspicion for measuring testosterone levels in men undergoing opioid therapy and assessing hormonal function in women.…”

Section: Endocrinementioning

confidence: 99%

Opioids for neuropathic pain

Katz

Benoit

2005

Current Science Inc

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Whether opioids are effective for neuropathic pain has been a matter of controversy for decades. Within limits, it is clear that opioids in general are effective for neuropathic pain. Furthermore, there is no evidence that opioids are any less effective for neuropathic pain than for non-neuropathic pain, no evidence that opioids are less effective for neuropathic pain than are other medications, and no evidence that one opioid is any more effective than another for neuropathic pain. It remains uncertain whether opioids are effective for central pain, although they may have a role. Although some patients appear to enjoy long-term benefits, most studies have been short-term. Opioids have an important role in the treatment of neuropathic pain; however, skillful opioid use balances the benefits with management of side effects and prevention and treatment of abuse and addiction.

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Hypogonadism in Patients Treated With Intrathecal Morphine

Abstract: Hypogonadotrophic hypogonadism is a common complication of intrathecal opioid therapy in both men and women.

Cited by 119 publications

References 14 publications

Sexual Dysfunction in Patients with Chronic Pain

Sexual Dysfunction in Patients with Chronic Pain

Adverse Effects of Drugs on Bone and Calcium Metabolism/Physiology

Opioids for neuropathic pain

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