Unidad de Investigación, Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España.
Unidad de Andrología, Hospital General Universitario de Alicante (HGUA), Alicante, España; Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España.
Med Clin (Barc). 2017 Jul 21;149(2):49-54. doi: 10.1016/j.medcli.2016.12.038. Epub 2017 Feb 22.
Chronic pain is associated with comorbidities that have an impact on the quality of life of patients and, among others, affect their sexual functioning. One of the most relevant side effects of opioid analgesics is erectile dysfunction (ED), due in part to the inhibition of the gonadal-pituitary-hypothalamic axis and the decline in testosterone levels. To evaluate ED and effectiveness of treatment in men with chronic pain treated with long-term opioids.
Prospective observational study lasting 3 years, where the intensity of pain (visual analogue scale, 0-10cm), erectile function (IIEF-EF, range 1-30 points), quality of life (EQ-VAS, 0-100mm), quality of sexual life (MSLQ-QOL, 0-100 points), anxiety/depression (HAD, 0-21 points) and testosterone levels, was assessed in patients who reported sexual dysfunction (ED or libido modification). A 6-month follow-up was applied to each patient after administering the usual treatment in the Andrology Unit. The study was approved by the Clinical Research Ethics Committee and data were statistically analyzed with the GraphPad Prism 5 software.
ED was observed in 27.6% of patients (n=105, 57±12.2 years, mean dose of morphine equivalent=107.1±107.9mg/day, 84.3% adjuvant analgesics). After 6 months, 42% of patients showed a significant improvement after being treated with iPDE5 (48.5%) and/or testosterone gel (81.8%), with a resolution rate of 31% (p=0.000). A positive correlation was observed between the improvement of IIEF and quality of sexual life (55.5±25.7 points, p=0.000), as well as anxiety (7.4±4.3 points, p=0.048). No significant changes were observed in the levels of testosterone, in the levels of pain nor in the quality of life, which remained moderate.
Erectile function and quality of sexual life, as well as anxiety, improved in patients treated chronically with opioids after administering andrological treatment. The management of patients with pain should include a review of their sexual health history given the significant emotional impact posed to the patient, the impact on their overall quality of life and its good clinical response to an interdisciplinary treatment.
慢性疼痛与合并症相关，这些合并症会影响患者的生活质量，其中包括影响他们的性功能。阿片类镇痛药最相关的副作用之一是勃起功能障碍（ED），部分原因是性腺-垂体-下丘脑轴的抑制和睾酮水平下降。评估长期接受阿片类药物治疗的慢性疼痛男性的 ED 及其治疗效果。
这是一项为期 3 年的前瞻性观察研究，评估了疼痛强度（视觉模拟评分，0-10cm）、勃起功能（IIEF-EF，范围 1-30 分）、生活质量（EQ-VAS，0-100mm）、性生活质量（MSLQ-QOL，0-100 分）、焦虑/抑郁（HAD，0-21 分）和睾酮水平，对报告性功能障碍（ED 或性欲改变）的患者进行评估。对每位患者进行了为期 6 个月的随访，然后在男科进行常规治疗。该研究得到了临床研究伦理委员会的批准，数据使用 GraphPad Prism 5 软件进行了统计学分析。
27.6%的患者（n=105，57±12.2 岁，平均吗啡等效剂量=107.1±107.9mg/天，84.3%辅助镇痛药）出现 ED。6 个月后，42%的患者接受 iPDE5（48.5%）和/或睾酮凝胶（81.8%）治疗后，勃起功能显著改善，缓解率为 31%（p=0.000）。IIEF 改善与性生活质量（55.5±25.7 分，p=0.000）以及焦虑（7.4±4.3 分，p=0.048）呈正相关。睾酮水平、疼痛程度和生活质量均无显著变化，仍处于中度水平。
长期接受阿片类药物治疗的患者接受男科治疗后，勃起功能和性生活质量以及焦虑得到改善。由于疼痛对患者的情绪影响重大，对整体生活质量的影响以及对跨学科治疗的良好临床反应，对疼痛患者的管理应包括对其性功能健康史的审查。
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