title: Prescription opioids for back pain and use of medications for erectile dysfunction.
abstract: METHODS
  Cross-sectional analysis of electronic medical and pharmacy records.
  
  
  OBJECTIVE
  To examine associations between use of medication for erectile dysfunction or testosterone replacement and use of opioid therapy, patient age, depression, and smoking status.
  
  
  BACKGROUND
  Males with chronic pain may experience erectile dysfunction related to depression, smoking, age, or opioid-related hypogonadism. The prevalence of this problem in back pain populations and the relative importance of several risk factors are unknown.
  
  
  METHODS
  We examined electronic pharmacy and medical records for males with back pain in a large group model health maintenance organization during 2004. Relevant prescriptions were considered for 6 months before and after the index visit.
  
  
  RESULTS
  There were 11,327 males with a diagnosis of back pain. Males who received medications for erectile dysfunction or testosterone replacement (n = 909) were significantly older than those who did not and had greater comorbidity, depression, smoking, and use of sedative-hypnotics. In logistic regressions, the long-term use of opioids was associated with greater use of medications for erectile dysfunction or testosterone replacement compared with no opioid use (odds ratio, 1.45; 95% confidence interval, 1.12-1.87, P < 0.01). Age, comorbidity, depression, and use of sedative-hypnotics were also independently associated with the use of medications for erectile dysfunction or testosterone replacement. Patients prescribed daily opioid doses of 120 mg of morphine-equivalents or more had greater use of medication for erectile dysfunction or testosterone replacement than patients without opioid use (odds ratio, 1.58; 95% confidence interval, 1.03-2.43), even with adjustment for the duration of opioid therapy.
  
  
  CONCLUSIONS
  Dose and duration of opioid use, as well as age, comorbidity, depression, and use of sedative-hypnotics, were associated with evidence of erectile dysfunction. These findings may be important in the process of decision making for the long-term use of opioids.
  
  
  METHODS
  4.
authors: Department of Family Medicine, Center for Research on Occupational and Environmental Toxicology, Portland, OR, USA. deyor@ohsu.edu
authors: Richard A
authors: RA
authors: Deyo
authors: David H M
authors: DH
authors: Smith
authors: Eric S
authors: ES
authors: Johnson
authors: Carrie J
authors: CJ
authors: Tillotson
authors: Marilee
authors: M
authors: Donovan
authors: Xiuhai
authors: X
authors: Yang
authors: Amanda
authors: A
authors: Petrik
authors: Benjamin J
authors: BJ
authors: Morasco
authors: Steven K
authors: SK
authors: Dobscha
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000728:Androgens / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy* / Q000453:epidemiology; D002243:Carbolines / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D007172:Erectile Dysfunction / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology; D020249:Hormone Replacement Therapy; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D007348:Insurance, Health / Q000458:organization & administration / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use; D015995:Prevalence; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D012907:Smoking / Q000453:epidemiology; D013450:Sulfones / Q000627:therapeutic use; D000068581:Tadalafil; D013739:Testosterone / Q000627:therapeutic use*; D014227:Triazines / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D064804:Urological Agents / Q000627:therapeutic use; D000069058:Vardenafil Dihydrochloride
chemical_list: D000701:Analgesics, Opioid; D000728:Androgens; D002243:Carbolines; D007093:Imidazoles; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014227:Triazines; D064804:Urological Agents; D013739:Testosterone; D000069058:Vardenafil Dihydrochloride; D000068581:Tadalafil; D000068677:Sildenafil Citrate