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Advise men taking opioids of erectile dysfunction risk, say researchers

GPs have been urged to remind all patients taking opioids for back pain that they have a higher risk of erectile dysfunction.

The study

The US researchers looked at 11,327 adult men with lower back pain and assessed their opioid use. Opiod use for six months before and six months after the a visit to their physician for back pain was analysed and characterised as ‘none’, ‘short-term’ (≤90 days), ‘episodic’ or ‘long term’ (≥120 days or >90 days with ≥10 fills). Prescriptions for sildenafil, tadalafil, and vardenafil were also recorded.  

The findings

Some 909 patients were prescribed medications for erectile dysfunction or testosterone replacement, and were significantly older than those who were not (mean age 55.7 years vs. 48.0 years). Prescriptions for erectile dysfunction or testosterone replacement ‘increased with increasing dose and duration of opioid use’. When combined, these medications were prescribed for 13.1% of patients receiving long-term opioids. More than 19% of patients receiving long-term opioids at doses >120 morphine-equivalents received prescriptions for erectile dysfunction or testosterone replacement, in contrast to 12.5% of patients receiving lower doses (1-120 morphine equivalents) of long-acting opioids and 6.7% of patients with back pain but no opioid treatment.

What this means for GPs

The researchers advise that for clinicians their data ‘provide a reminder that information on sexual dysfunction should be part of clinical decision making with regard to long-term pain management’ and that ‘both patients and clinicians should recognize possible opioid effects on sexual functioning in considering treatment options’.  

Spine 2013; 38: 905-915