Prescription Opioids for Back Pain and Use of Medications for Erectile Dysfunction
Deyo RA, Smith DH, Johnson ES, Tillotson CJ, Donovan M, Yang X, Petrik A, Morasco BJ, Dobscha SK. Spine (Phila Pa 1976). 2013 Mar 1. [Epub ahead of print]

Source

From the Departments of Family Medicine, Medicine, Public Health and Preventive Medicine, Psychiatry, and the Center for Research on Occupational and Environmental Toxicology, Oregon Health and Science University; Kaiser Permanente Center for Health Research; and the Portland VA Medical Center, Portland, OR.

Abstract

Study Design. Cross-sectional analysis of electronic medical and pharmacy records.Objective. To examine associations between use of medication for erectile dysfunction or testosterone replacement and use of opioid therapy, patient age, depression, and smoking statusSummary of Background Data. Men with chronic pain may experience erectile dysfunction related to depression, smoking, age, or opioid-related hypogonadism. The prevalence of this problem in back pain populations and the relative importance of several risk factors are unknown.Methods. We examined electronic pharmacy and medical records for men with back pain in a large group model HMO during 2004. Relevant prescriptions were considered for six months before and after the index visit.Results. There were 11,327 men with a diagnosis of back pain. Men who received medications for erectile dysfunction or testosterone replacement (n = 909) were significantly older than those who did not, and had greater comorbidity, depression, smoking, and use of sedative-hypnotic medications. In logistic regressions, long-term opioid use was associated with greater use of medications for erectile dysfunction or testosterone replacement, compared to patients with no opioid use (OR 1.45, 95% CI 1.12, 1.87, p<0.01). Age, comorbidity, depression, and use of sedative-hypnotics were also independently associated with use of medications for erectile dysfunction or testosterone replacement. Patients prescribed daily opioid doses of 120 mg morphine-equivalent or more had greater use of medication for erectile dysfunction or testosterone replacement than patients without opioid use (OR 1.58, 95% CI 1.03, 2.43), even with adjustment for duration of opioid therapy.Conclusion. Opioid dose and duration, as well as age, comorbidity, depression, and use of sedative-hypnotics were associated with evidence of erectile dysfunction. These findings may be important in the process of decision-making for long-term opioid use.