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Exp Clin Endocrinol Diabetes 2009; 117(1): 38-43
DOI: 10.1055/s-2008-1076715
Article

© Georg Thieme Verlag KG Stuttgart · New York

Oral Opioids for Chronic Non-cancer Pain: Higher Prevalence of Hypogonadism in Men than in Women

L.-A. Fraser 1 [*] , D. Morrison 1 [*] , P. Morley-Forster 2 , T. L. Paul 1 , S. Tokmakejian 3 , R. Larry Nicholson 4 , Y. Bureau 5 , T. C. Friedman 6 , S. H. M. Van Uum 1
  • 1Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
  • 2Interdisciplinary Pain Program, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
  • 3Department of Biochemistry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
  • 4Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
  • 5Department of Psychology, University of Western Ontario, London, Ontario, Canada
  • 6Division of Endocrinology, Metabolism and Molecular Medicine, Charles R. Drew University of Medicine & Sciences, Los Angeles, California, USA
Further Information

Publication History

received 24.01.2008 first decision 11.04.2008

accepted 11.04.2008

Publication Date:
03 June 2008 (online)

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Abstract

The effect of chronic oral opioids on hypothalamus-pituitary-gonadal axis in women, and on bone mineral density (BMD) in men and women is not known. The objective of this cross-sectional study was to determine the effect of long-term oral opioids on gonadal status and BMD in male and female patients with chronic non-cancer pain (CNCP). We included 26 community-dwelling CNCP patients, 12 men and 14 premenopausal women, treated with oral opioids for at least one year. We obtained Visual Analogue Scale for pain score, BMD and plasma LH and FSH in all patients; menstrual history and estradiol in women; free androgen index and total and free testosterone in men. Men were older then women (p<0.05) and had used opioids for a longer period (7.2±3.8 and 4.1±1.8 years, respectively; p<0.05), but there was no difference in opioid dose or pain score between sexes. The prevalence of hypogonadism was high in men (75%), while only 21% of the women reported oligo- or amenorrhea indicating hypogonadism (P<0.01, between sexes). Osteopenia was found in 50% of men and 21% of women (p=NS). We conclude that in CNCP patients receiving chronic opioid therapy there is a much higher prevalence of hypogonadism in men then in women. This needs to be considered clinical practice.

Key words

opioids - hypogonadism - chronic pain - osteopenia/osteoporosis

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1 Both Authors contributed equally to this publication

Correspondence

S.H.M. Van UumMD, PhD 

Department of Medicine

University of Western Ontario

St. Joseph's Health Care

Room E4-101

268 Grosvenor St.

London

Ontario N6A 4V2

Canada

Phone: 1/519/646 61 70

Fax: 1/519/646 60 58

Email: Stan.VanUum@sjhc.london.on.ca

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