Opioids Increase Sexual Dysfunction in Patients with Non-Cancer Pain

Abstract

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 = 30–100.6, 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.

Pharmacogenetics and prediction of adverse events in prescription opioid use disorder patients

“…37,38 Although the underlying reasons are not clear because women are only included in 38% of human research studies, hormonal factors, differences in pharmacokinetics and pharmacodynamics may play a significant role. 39 This discrepancy might be explained too much emphasis placed on sexual dysfunction because of a parallel open study of long-term opioid patients in our unit at that time, 40,41 as 67% of males suspected ADRs in our study are loss of libido or erectile dysfunction.…”

Sexual life satisfaction of methadone-maintained Chinese patients: individuals with pain are dissatisfied with their sex lives

“…Pain is another common complaint of methadone-maintained patients, which refers to “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” 13 – 16 Due to concerns about opioid dependence as a barrier to pain management, pain is also often undertreated or untreated in addiction treatment practice. 13 , 17 Previous studies have reported a high prevalence of sexual dysfunction in patients with painful conditions (ie, chronic pelvic pain syndrome and chronic low back pain), 18 – 20 which is particularly high among those with intensive and severe pain. 20 Therefore, we speculate that pain is associated with sexual dysfunction in methadone-maintained patients.…”

“… 13 , 17 Previous studies have reported a high prevalence of sexual dysfunction in patients with painful conditions (ie, chronic pelvic pain syndrome and chronic low back pain), 18 – 20 which is particularly high among those with intensive and severe pain. 20 Therefore, we speculate that pain is associated with sexual dysfunction in methadone-maintained patients. However, results of our literature search within major Chinese and English databases (from their inception date to July 24, 2018) showed that no studies have examined the potential effect of pain on sexual function in methadone-maintained patients.…”

Opioid‐induced hypogonadism: Pathophysiology, clinical and therapeutics review

“…Buprenorphine and tramadol elucidated less hazard on the gonadal hormonal functionality which is attributed to their partial agonistic effect of mu receptors. 48,64,67,68 Furthermore, using opioids through the intrathecal route is found to be associated with higher prevalence of OHG compared to the oral Erectile dysfunction √ -- [121][122][123][124] counterpart. 69 However, opioid-induced hypogonadism is reversible on discontinuation of opioid, even among long-term therapy.…”