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19-05-2013 | Urology | Article

Back pain medication link to erectile dysfunction

medwireNews: Results of a large US study show that men who are prescribed opioids for back pain are significantly more likely to require medications for erectile dysfunction and testosterone depletion than those who have not taken the drugs.

"For clinicians, our data provide a reminder that information on sexual dysfunction should be part of clinical decision making with regard to long-term pain management," say authors Richard Deyo (Kaiser Center for Health Research, Portland, Oregon) and colleagues.

The study included 11,327 men diagnosed with back pain during 2004, with a mean age of 48.6 years. Overall, 4696 had short-term use (≤90 days) of opioids, 164 had episodic use (91-119 days use, <10 prescriptions), and 1812 had long-term use (≥120 days, or >90 days with ≥10 prescriptions), while the remaining men did not use opioids during the study period.

The researchers found that prescriptions for erectile dysfunction treatments or testosterone replacement 6 six months either side of the index visit increased significantly with rising dose and duration of opioid use. For example, 13.1% of men receiving long-term opioids also received one of these treatments, compared with 7.4% of short-term opioid users, and 6.7% of patients who did not take opioids.

Meanwhile, sexual dysfunction treatment was given to 19.3% of patients who used long-term opioids at high doses (>120 morphine-equivalents/day) compared with 16.3% of episodic users and 7.7% of short-term users of this dosing level.

Multivariate analysis showed that after adjusting for confounding factors, including age and cormorbidity, long-term use of opioids was independently associated with a 45% increased odds for use of erectile dysfunction treatment or testosterone replacement compared with patients who did not take them.

And, while there was no association with lower doses of opioids, patients who received high doses had a 58% increased odds for receiving erectile dysfunction treatment or testosterone replacement.

"Thus, the combination of long-term and high-dose opioid use seems most strongly associated with markers of sexual dysfunction," comment Deyo and colleagues in Spine.

They also note that prescriptions for sedative-hypnotics and diagnoses of depression were also independently associated with the odds for erectile dysfunction treatment or testosterone replacement.

The authors say that their findings cannot be used to support a previously reported association between hypogonadism and opioid use.

Nevertheless, "some evidence suggests that identifying and treating sexual dysfunction and possible hypogonadism among long-term opioid users may reduce pain and depression, minimizing opioid requirements," they note.

"Obtaining better information on sexual dysfunction among patients with chronic pain remains a high priority for future research," the authors conclude.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter

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