Men using long-term, high-dose prescription opioids for back pain were about 50% more likely to be using medications for erectile dysfunction than men with back pain who were not using opioids, researchers reported.
In a 2004 cross-sectional examination of electronic medical records and pharmacy records for men with back pain in a large integrated HMO, the authors considered relevant prescriptions for 6 months before and after the index visit. There were 11,327 males with a diagnosis of back pain. The men who received medications for ED or testosterone replacement (909 patients) were significantly older than those who did not and had greater comorbidity, depression, smoking, and use of sedative-hypnotics.
In logistic regressions, long-term opioid use was associated with greater use of medications for ED or testosterone replacement compared with no opioid use (odds ratio: 1.45; 95% CI: 1.12–1.87; p<.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 ED or testosterone replacement than patients without opioid use (odds ratio: 1.58; 95% CI: 1.03–2.43), even with adjustment for the duration of opioid therapy.
“This was true even after adjusting for other important correlates of erectile dysfunction such as age, comorbid illness, depression, and other medications,” said lead author Richard Deyo, MD, MPH, of Oregon Health and Science University, Portland.
“Men should be aware that erectile dysfunction is a potential side effect of long-term, high-dose opioid therapy,” Dr. Deyo added. “Doctors and patients should be aware of this when considering options for chronic pain management, especially because non-pharmacologic treatments-such as rigorous exercise and cognitive-behavioral therapy-may be at least as effective. This should be part of a shared decision-making process regarding management of chronic pain.”
Findings from the study were published in Spine (2013; 38:909-15).
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