title: Opioids Increase Sexual Dysfunction in Patients With Non-Cancer Pain.
abstract: Long-term opioid therapy has been found to have a strong impact on the hypothalamic-pituitary-gonadal axis that can be manifested clinically by sexual dysfunction (SD). This event is rarely reported and thus unnoticed and undertreated.
  
  
  
  To analyze the presence of SD in a large group of patients receiving long-term opioids.
  
  
  
  A descriptive, cross-sectional pilot study of sexual health was conducted for 2 years in 750 consecutive ambulatory patients with chronic non-cancer pain (CNP) receiving opioids for at least 12 months. Cases that reported SD and matched controls were included. Standardized questionnaires and medical record reviews were used to assess rates of pain at diagnosis, daily morphine equivalent doses, and opioid adverse effects.
  
  
  
  Sexual function was determined by the Female Sexual Function Index (FSFI; scores = 2-36) and the International Index of Erectile Function erectile function domain (IIEF-EF; scores = 1-30).
  
  
  
  Thirty-three percent of 33% of 750 patients with CNP recorded SD based on their spontaneous notification at the pain unit. Men reported SD significantly more frequently than women (33% vs 25%, respectively, P < .05), although they reported having a regular partner (84% vs 70%, P = .03) and a sexually active life (69% vs 34%, respectively, P = .00) significantly more often. FSFI scores were significantly influenced by sexual activity in lubrication and arousal. IIEF scores were significantly determined by age in satisfaction with sexual intercourse and overall satisfaction. The morphine equivalent dose was significant higher in men than in women (38%; median = 70 mg/d, interquartile range = 43.1-170, 115.5 ± 110.3 mg/d vs median = 60 mg/d, interquartile range = 30-100.6, 76.67 ± 63.79 mg/d, P = .016) at the same mean intensity of pain (P = .54), which correlated to FSFI scores (r = -0.313, P = .01).
  
  
  
  SD is prevalent in patients with CNP and higher in men who received a significantly higher mean opioid dose at the same intensity pain level than women. The morphine equivalent dose was correlated to SD intensity. Evidence-based interventions to support sexual activity and function in CNP are needed.
authors.affiliation: Pain Unit, Department of Health of Alicante, General Hospital, Alicante, Spain; Neuropharmacology on Pain Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Ajo
authors.affiliation: Neuropharmacology on Pain Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain; Andrology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Segura
authors.affiliation: Neuropharmacology on Pain Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain.
authors.forename: María M
authors.initials: MM
authors.lastname: Inda
authors.affiliation: Pain Unit, Department of Health of Alicante, General Hospital, Alicante, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Planelles
authors.affiliation: Clinical Psychology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain.
authors.forename: Luz
authors.initials: L
authors.lastname: Martínez
authors.affiliation: Andrology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain; Occupational Observatory, Miguel Hernández University of Elche, Elche, Spain.
authors.forename: Guillermina
authors.initials: G
authors.lastname: Ferrández
authors.affiliation: Operations Research Centre, Miguel Hernández University of Elche, Elche, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Sánchez
authors.affiliation: Neuropharmacology on Pain Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain.
authors.lastname: César Margarit
authors.affiliation: Pain Unit, Department of Health of Alicante, General Hospital, Alicante, Spain; Neuropharmacology on Pain Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain; Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain. Electronic address: peiro_ana@gva.es.
authors.forename: Ana-María
authors.initials: AM
authors.lastname: Peiró
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D012725:Sexual Behavior / Q000187:drug effects*; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced*; D012747:Sexual Partners; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid
keywords: ADRs; Chronic Non-Cancer Pain; Erectile Function; Female Sexual Function Index; International Index of Erectile Function; Long-Term Opioid; Sexual Dysfunction