Opioids Increase Sexual Dysfunction in Patients With Non-Cancer Pain
Por:
Ajo R, Segura A, Inda MD, Planelles B, Martínez L, Ferrández G, Sánchez A, César Margarit and Peiró AM
Publicada:
1 sep 2016
Resumen:
Introduction: Long-term opioid therapy has been found to have a strong
impact on the hypothalamic-pituitary-gonadal axis that can be manifested
clinically by sexual dysfunction (SD). This event is rarely reported and
thus unnoticed and undertreated.
Aim: To analyze the presence of SD in a large group of patients
receiving long-term opioids.
Methods: A descriptive, cross-sectional pilot study of sexual health was
conducted for 2 years in 750 consecutive ambulatory patients with
chronic non-cancer pain (CNP) receiving opioids for at least 12 months.
Cases that reported SD and matched controls were included. Standardized
questionnaires and medical record reviews were used to assess rates of
pain at diagnosis, daily morphine equivalent doses, and opioid adverse
effects.
Main Outcome Measures: Sexual function was determined by the Female
Sexual Function Index (FSFI; scores = 2-36) and the International Index
of Erectile Function erectile function domain (IIEF-EF; scores = 1-30).
Results: Thirty-three percent of 33% of 750 patients with CNP recorded
SD based on their spontaneous notification at the pain unit. Men
reported SD significantly more frequently than women (33% vs 25%,
respectively, P <.05), although they reported having a regular partner
(84% vs 70%, P =.03) and a sexually active life (69% vs 34%,
respectively, P =.00) significantly more often. FSFI scores were
significantly influenced by sexual activity in lubrication and arousal.
IIEF scores were significantly determined by age in satisfaction with
sexual intercourse and overall satisfaction. The morphine equivalent
dose was significant higher in men than in women (38%; median = 70 mg/d,
interquartile range = 43.1-170, 115.5 +/- 110.3 mg/d vs median = 60
mg/d, interquartile range = 30e100.6, 76.67 +/- 63.79 mg/d, P =.016) at
the same mean intensity of pain (P =.54), which correlated to FSFI
scores (r = -0.313, P =.01).
Conclusion: SD is prevalent in patients with CNP and higher in men who
received a significantly higher mean opioid dose at the same intensity
pain level than women. The morphine equivalent dose was correlated to SD
intensity. Evidence-based interventions to support sexual activity and
function in CNP are needed. Copyright (C) 2016, International Society
for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Filiaciones:
:
Pain Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
Neuropharmacology on Pain Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain
:
Andrology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
:
Neuropharmacology on Pain Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain
:
Clinical Psychology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
:
Occupational Observatory, Miguel Hernández University of Elche, Elche, Spain
Sánchez A:
Operations Research Centre, Miguel Hernández University of Elche, Elche, Spain
:
Neuropharmacology on Pain Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain
:
Pain Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain.
|