The authors of this research note that multiple factors may be associated with sexual dysfunction in patients with chronic pain, aside from the condition itself (e.g. depression, smoking, use of opioids). Although hypogonadism as a result of opioid therapy has recently been documented, its prevalence, risk factors and functional significance are unknown.
In their research, they studied the use of medication for erectile dysfunction or testosterone replacement as proxies for sexual dysfunction, and examined their relationship to chronic opioid therapy in adult men with chronic back pain who were enrolled in the Kaiser Permanente Northwest healthcare system (n=11,327). After adjusting for potential confounders (age, depression, smoking status, medical co-morbidities), the long-term use of opioids (≥120 or >90 days with ≥10 fills) was associated with greater use of medications for erectile dysfunction or testosterone replacement compared with no opioid use (odds ratio [OR] 1.45; 95% CI 1.12–1.87, P<0.01). Age, depressive disorders and use of sedative-hypnotics were also independently associated with the use of medications for erectile dysfunction or testosterone replacement.
The authors note the following limitations of their study:
• Use of medications for erectile dysfunction or testosterone replacement as a marker of sexual dysfunction may underestimate its actual prevalence.
• The original indication for prescribing opioids is unknown
• It is not known if the observed associations are causal
• Sexual dysfunction may have preceded the use of opioid therapy (as medication use was measured six months before and after the index back pain visit)
• Individuals with diabetes could not be identified and this is a potential confounder
The say that their findings provide a reminder for clinicians that information on sexual dysfunction should be part of clinical decision making with regard to long-term pain management.