Opioid painkillers could cause sexual problems for men

Doctors are being advised to inform male patients who are prescribed opioid painkillers that it could affect their sex life. More specifically, these types of medications could leave men at a much higher risk of suffering with erectile dysfunction (male impotence).

The warnings stem from a new study pioneered by lead author Dr Richard A. Deyo, an investigator with the Kaiser Permanente Center for Health Research, whose findings are published in the 15 May online issue of the journal Spine.

The study findings indicate that taking opioid prescription painkillers for the treatment of back pain could lead to the development of erectile dysfunction (ED). Dr Deyo comments: “Men who take opioid pain medications for an extended period of time have the highest risk of ED. This doesn’t mean that these medications cause ED, but the association is something patients and clinicians should be aware of when deciding if opioids should be used to treat back pain.There is no question that for some patients opioid use is appropriate, but there is also increasing evidence that long-term use can lead to addiction, fatal overdoses, sleep apnea, falls in the elderly, reduced hormone production, and now erectile dysfunction.”

Opioids connect to opioid receptors within the brain, spinal cord, and places around the body. They restrict the ability of pain messages being transmitted to the brain, thus decreasing how much pain we feel. Opioid drugs include codeine, methadone, morphine and oxycodone. They are primarily used to relieve moderate to severe pain which isn’t subsiding after taking other, usually weaker, pain medications.

Dr Deyo and his colleagues decided to conduct their study after acknowledging that many men with chronic pain can also develop erectile dysfunction from a number of reasons including: age, smoking, depression, or opioid-related hypogonadism (low testosterone due to painkiller use).

However, they realised there is very little information regarding any potential correlations with erectile dysfunction in men who are suffering with back pain, and any crucial risk factors that can come into play.

The researchers were curious to find out if men prescribed painkillers, were also later prescribed testosterone replacement or ED treatments such as Viagra, Cialis or Levitra.

To do this, they studied 11,327 males from Oregon or Washington who were enlisted in the Kaiser Permanente health plan. All men had visited their doctor during 2004 complaining of back pain.
Pharmacy records spanning six months prior and six months after the back pain complaint were analysed to see if and/or when the men had been prescribed opioids and testosterone replacement or ED medications.

From the men who were taking low-dose opioids for a period of at least four months, it was found that 12% had also received prescriptions for testosterone replacement or ED medications.

However, it was discovered that over 19% of men who took high-dose opioids (classed as more than 120 mg of morphine-equivalent) for the same amount of time, were then also prescribed testosterone replacement or medications for ED. Dr Deyo says: “That could well be an underestimate, because many don’t bring it to their doctor’s attention, would be embarrassed or wouldn’t connect it to medication.” In addition, 6.7% of the men with back pain had received ED prescriptions, but had not been prescribed any opioids.

Dr Deyo concludes: “Opioid use and erectile dysfunction seem to go together, but we have to be cautious about saying one causes the other.”