title: Hypogonadism associated with long-term opioid therapy: A systematic review.
abstract: BACKGROUND
  Sexual dysfunction and Opioid-Induced Sexual Hormone Deficiency (OPISHD) have been associated with patients on long-term opioid pain therapy. There have been few comprehensive reviews to establish a relation between hypogonadism with chronic opioid pain management. The OPISHD is often not treated and literature guiding this topic is scarce.
  
  
  OBJECTIVE
  To investigate hypogonadism associated with long-term opioid therapy based on qualitative data analysis of the available literature.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  The review included relevant literature identified through searches of PubMed, Cochrane, Clinical Trials, US National Guideline Clearinghouse, and EMBASE, for the years 1960 to September 2013. The quality assessment and clinical relevance criteria used were the Cochrane Musculoskeletal Review Group Criteria for randomized control trials and the Newcastle-Ottawa Scale Criteria for observational studies. The level of evidence was classified as good, fair, and poor, based on the quality of evidence.
  
  
  METHODS
  The primary outcome measures were clinical symptoms and laboratory markers of hypogonadism. Secondary outcome measure was management of OPISHD.
  
  
  RESULTS
  Thirty-one studies were identified, of which 14 studies met inclusion criteria. There were no randomized control trials and eight of 14 studies were of moderate quality. The remaining studies were of poor quality. Four studies report most patients on long-term oral opioid therapy have associated hypogonadism and three studies of patients receiving intrathecal opioid therapy suggest that hypogonadism is common.
  
  
  CONCLUSIONS
  There is lack of high-quality studies to associate chronic opioid pain management with hypogonadism. At present, there is fair evidence to associate hypogonadism with chronic opioid pain management, and only limited evidence for treatment of OPISHD.
authors.affiliation: Pain Management Service, Saint Francis Medical Center, Grand Island, Nebraska.
authors.forename: Pravardhan
authors.initials: P
authors.lastname: Birthi
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky.
authors.forename: Vittal R
authors.initials: VR
authors.lastname: Nagar
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky.
authors.forename: Robert
authors.initials: R
authors.lastname: Nickerson
authors.affiliation: Department of Anesthesiology, University of Kentucky, Lexington, Kentucky.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sloan
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007006:Hypogonadism / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D009292:Narcotic Antagonists