title: Erectile dysfunction in patients with chronic pain treated with opioids.
abstract: OBJECTIVE
  Chronic pain is associated with comorbidities that have an impact on the quality of life of patients and, among others, affect their sexual functioning. One of the most relevant side effects of opioid analgesics is erectile dysfunction (ED), due in part to the inhibition of the gonadal-pituitary-hypothalamic axis and the decline in testosterone levels. To evaluate ED and effectiveness of treatment in men with chronic pain treated with long-term opioids.
  
  
  METHODS
  Prospective observational study lasting 3 years, where the intensity of pain (visual analogue scale, 0-10cm), erectile function (IIEF-EF, range 1-30 points), quality of life (EQ-VAS, 0-100mm), quality of sexual life (MSLQ-QOL, 0-100 points), anxiety/depression (HAD, 0-21 points) and testosterone levels, was assessed in patients who reported sexual dysfunction (ED or libido modification). A 6-month follow-up was applied to each patient after administering the usual treatment in the Andrology Unit. The study was approved by the Clinical Research Ethics Committee and data were statistically analyzed with the GraphPad Prism 5 software.
  
  
  RESULTS
  ED was observed in 27.6% of patients (n=105, 57±12.2 years, mean dose of morphine equivalent=107.1±107.9mg/day, 84.3% adjuvant analgesics). After 6 months, 42% of patients showed a significant improvement after being treated with iPDE5 (48.5%) and/or testosterone gel (81.8%), with a resolution rate of 31% (p=0.000). A positive correlation was observed between the improvement of IIEF and quality of sexual life (55.5±25.7 points, p=0.000), as well as anxiety (7.4±4.3 points, p=0.048). No significant changes were observed in the levels of testosterone, in the levels of pain nor in the quality of life, which remained moderate.
  
  
  CONCLUSIONS
  Erectile function and quality of sexual life, as well as anxiety, improved in patients treated chronically with opioids after administering andrological treatment. The management of patients with pain should include a review of their sexual health history given the significant emotional impact posed to the patient, the impact on their overall quality of life and its good clinical response to an interdisciplinary treatment.
authors.affiliation: Unidad de Investigación, Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España.
authors.forename: Raquel
authors.initials: R
authors.lastname: Ajo
authors.affiliation: Unidad de Andrología, Hospital General Universitario de Alicante (HGUA), Alicante, España; Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Segura
authors.affiliation: Unidad de Investigación, Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España; Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España.
authors.forename: María-Del-Mar
authors.initials: MD
authors.lastname: Inda
authors.affiliation: Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España; Unidad de Dolor (UDO), Hospital General Universitario de Alicante (HGUA), Alicante, España.
authors.forename: César
authors.initials: C
authors.lastname: Margarit
authors.affiliation: Unidad de Investigación, Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España; Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España.
authors.forename: Pura
authors.initials: P
authors.lastname: Ballester
authors.affiliation: Observatorio Ocupacional, Universidad Miguel Hernández (UMH), Elche, España.
authors.forename: Emi
authors.initials: E
authors.lastname: Martínez
authors.affiliation: Unidad de Andrología, Hospital General Universitario de Alicante (HGUA), Alicante, España.
authors.forename: Guillermina
authors.initials: G
authors.lastname: Ferrández
authors.affiliation: Centro de Investigación Operacional (CIO), Universidad Miguel Hernández (UMH), Elche, España.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Sánchez-Barbie
authors.affiliation: Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España; Unidad de Farmacología Clínica, Hospital General Universitario de Alicante (HGUA), Alicante, España. Electronic address: peiro_ana@gva.es.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Peiró
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D000728:Androgens / Q000627:therapeutic use; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D007172:Erectile Dysfunction / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects* / Q000627:therapeutic use; D010147:Pain Measurement; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D013739:Testosterone / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000728:Androgens; D058986:Phosphodiesterase 5 Inhibitors; D013739:Testosterone; D009020:Morphine
keywords: Calidad de vida; Calidad de vida sexual; Chronic pain; Disfunción eréctil; Dolor crónico; Erectile dysfunction; IIEF-EF; MSLQ-QOL; Quality of life; Quality of sexual life; mSLQ-QOL