Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
Multidisciplinary Pain Centre, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
Scand J Pain. 2022 Mar 22;22(3):421-435. doi: 10.1515/sjpain-2021-0196. Print 2022 Jul 26.
Opioid analgesics are the main stay for cancer pain management; however, long-term opioid treatment (L-TOT) may suppress the endocrine system. This systemic review aimed at investigating effects of L-TOT on the endocrine system in patients with cancer-related pain.
A search on MEDLINE, EMBASE and Web of Science databases was performed. Inclusion criteria were clinical studies investigating endocrine measures in adult patients with cancer-related pain in L-TOT (≥4 weeks). Outcomes and quality of evidence were assessed.
A total of 252 abstracts were identified; out of which 247 were excluded and five cross-sectional studies were included and analyzed. L-TOT was associated with lower serum concentration levels of total- and free testosterone in males, follicular stimulating hormone in females, and luteinizing hormone in both sexes. Moreover, higher morphine equivalent daily doses (MEDDs) were correlated with higher levels of cortisol and lower levels of LH in both sexes, and lower levels of total- and free testosterone in males. Sexual dysfunction was associated with low sex hormone levels. Level of evidence was low/very low.
The studies identified demonstrated that patients with cancer-related pain in L-TOT may have gonadal hypofunction causing sexual dysfunction, which may be correlated with opioid dose level. In addition, high serum concentrations of cortisol were positively correlated with high opioid dose levels. However, the evidence was weak and further research is necessary. PROSPERO, ID-number: CRD42020213059.
阿片类镇痛药是癌症疼痛管理的主要手段；然而，长期阿片类药物治疗（L-TOT）可能会抑制内分泌系统。本系统评价旨在调查 L-TOT 对癌症相关疼痛患者内分泌系统的影响。
对 MEDLINE、EMBASE 和 Web of Science 数据库进行了检索。纳入标准为调查 L-TOT（≥4 周）中成年癌症相关疼痛患者内分泌测量的临床研究。评估了结局和证据质量。
共确定了 252 篇摘要；其中 247 篇被排除，纳入并分析了 5 项横断面研究。L-TOT 与男性总睾酮和游离睾酮、女性卵泡刺激素和两性黄体生成素的血清浓度水平降低有关。此外，较高的吗啡等效日剂量（MEDD）与两性的皮质醇水平升高和黄体生成素水平降低以及男性的总睾酮和游离睾酮水平降低有关。性功能障碍与低性激素水平有关。证据水平为低/非常低。
确定的研究表明，L-TOT 中患有癌症相关疼痛的患者可能存在性腺功能低下导致性功能障碍，这可能与阿片类药物剂量水平相关。此外，皮质醇的血清浓度升高与阿片类药物剂量水平升高呈正相关。然而，证据薄弱，需要进一步研究。PROSPERO，注册号：CRD42020213059。
