title: Chronic spinal and oral morphine-induced neuroendocrine and metabolic changes in noncancer pain patients.
abstract: OBJECTIVE
  Interactions between opioid use and hormonal function are documented in the literature. However, it is unclear if therapeutic intrathecal opioid therapy can induce hormonal changes, compared to oral opioid therapy.
  
  
  METHODS
  The authors studied hormone and metabolic changes in 22 women (18-60 years) and 38 men (18-45 years) who were referred to a pain center. The patients were allocated to different treatment groups (based on assistant physicians' decision), as follows: 20 patients received oral morphine (60-120 mg/day); 20 patients, spinal morphine (0.2-10 mg/day); and 20 patients, nonopioid analgesic treatment.
  
  
  RESULTS
  All three groups experienced substantial improvement in pain scores during the whole follow-up period. Significantly impaired libido, reduced potency, hot flashes, and menstrual cycle dysfunction occurred more often in both morphine groups than in the nonopioid group. Significantly low serum total testosterone levels were more prevalent in the spinal morphine group and the oral morphine group (58.3% and 70.0%, respectively) than in the control group (16.7%). Total cholesterol values above 200 mg/dL and higher ultrasensitive C-reactive protein levels were significantly more frequent in the morphine groups than in the controls. Total body bone mineral density was below normal in men receiving spinal morphine (P = 0.014).
  
  
  CONCLUSIONS
  Hypogonadotrophic hypogonadism was more prevalent in the morphine groups and was correlated with clinical findings. Significant bone mass loss occurred in morphine users, even without hormone dysfunction when compared to nonopioid treatment. Growth hormone, thyroid stimulating hormone, adrenocorticotrophic hormones, and cardiovascular risk parameters were less compromised in morphine users.
authors.affiliation: Department of Neurology, Pain Center and Division of Functional Neurosurgery.
authors.forename: João
authors.initials: J
authors.lastname: Valverde-Filho
authors.forename: Malebranche Berardo Carneiro
authors.initials: MB
authors.lastname: da Cunha Neto
authors.forename: Erich Talamoni
authors.initials: ET
authors.lastname: Fonoff
authors.forename: Eduardo de Souza
authors.initials: Ede S
authors.lastname: Meirelles
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Bone Loss; Chronic Noncancer Pain; Hormones; Intrathecal Therapy; Opiates