Painkillers for Back Pain Linked to Erectile Dysfunction

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By Margaret Jaworski

Regular use of opiod prescription painkillers is associated with a higher risk of erectile dysfunction (ED) in men, according to a study published on May 15, 2013 in the journal Spine.

Looking at the electronic medical records of 11,327 men diagnosed with back pain in 2004, researchers examined pharmacy records for the six months before and after the back pain visit and identified 909 men who received testosterone replacement or medication for erectile dysfunction.

The researchers characterized the 909 by the frequency and dosage of their opiod use. More than 19 percent of men who took high-dose opioids (an amount equivalent to more than 120 mg of morphine) for at least four months also received testosterone replacement or other ED prescriptions while fewer than 7 percent of men who did not take opioids received ED medication.

Not surprisingly, age was a significant factor. Men 60 to 69 were 14 times more likely to receive prescriptions for ED medication than men 18 to 29. Depression, other health conditions (besides back pain), and use of sedative hypnotics like benzodiazepines also increased the likelihood that men would receive ED prescriptions. But  even after researchers adjusted for age and other factors, men taking high-dose opioids were still 50 percent more likely to receive ED prescriptions than men who did not take prescription painkillers.

“Men who take opioid pain medications for an extended period of time have the highest risk of ED,” said lead author Richard A. Deyo, MD, MPH, investigator with the Kaiser Permanente Center for Health Research and Professor of Evidence-based Family Medicine at Oregon Health & Science University.

While the study did not establish that high-dose opiod use causes ED, “The association is something patients and clinicians should be aware of when deciding if opioids should be used to treat back pain,” Deyo added.

“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,” says Deyo, who has spent more than 30 years studying treatments for back pain.

Opioid prescription sales quadrupled between 1999 and 2010 according to the Centers for Disease Control and Prevention’s Mortality and Morbidity Report. Another recent survey, published in the journal Pain, estimates 4.3 million adults in the U.S. use these opioid medications on a regular basis. The most commonly used prescription opioids are hydrocodone, oxycodone, and morphine.

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