1. Do opioids work in chronic pain?
Opioids and female sexual dysfunction: a cross-sectional study
Richardson, E., Bedson, J., Chen, Y., Lacey, RJ.,Dunn, KM.
Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
OPIOIDS
Do opioids work in chronic pain?
Cochrane reviews unable to identify strong evidence for opioid effectiveness (1,2)
Opioids can be effective as part of a structured care programme with monitoring (3)
Are opioids safe?
Cochrane review significant risk of adverse events (long-term opioids vs placebo) (4)
Number needed to harm 4.2 ( ) (5)
Previous work
Systematic Review – 3 papers including low libido (6)
Cohort Study – <1% of women had low libido
No significant results in either
Sexual Dysfunction?
Sexual dysfunction seen in men with opioids
Sparse evidence in women
Needs further investigation
Aim – To investigate associations between opioid use in women with musculoskeletal conditions and Female Sexual Dysfunction (FSD)
Cross-Sectional Study
Methods
Cross-sectional study
18-45 year old women
Musculoskeletal condition and prescribed opioid (past 6 months)
30 general practices
1020 postal questionnaires
Total daily morphine equivalent dose calculated for each participant
Groups - 0mg/day, <20mg/day and ≥20mg/day
FSD assessed with STEFFI-5 (7)
Logistic regression for FSD
Female Sexual Dysfunction
Sensitivity analysis OR for ≥20mg opioids = 2.39 (1.01 – 5.67) (using STEFFI-2 to identify FSD)
Bivariate adjustment for pain grade, Age, BMI, PHQ-2. Direction of relationship remained consistent.
Opioid Category
No Opioid
<20mg
≥20mg
FSD
13 (31.7%)
16 (35.8%)
24 (50.0%)
Unadjusted OR (95% CI)
1.00 (reference)
1.28 (0.51 – 3.20)
2.29 (0.94 – 5.55)
Results
15% (153/1000) response rate
Responders vs. non-responders: older (38 (31-42) vs. 35 (29-41) p=0.03) and less deprived (p=0.02)
Conclusion
There appears to be a dose related response between opioid use and FSD. Increasing OR with increasing dose.
Low response rate
Unable to adjust statistical analysis
Decreased power
Increased risk of non-response bias
FSD should be considered when prescribing and reviewing opioids
Further work with larger numbers required to investigate further
Opioid Category P*
No Opioid
<20mg
≥20mg N
41 (28.1%)
46 (31.5%)
48 (32.9%)
BMI
24.4 ( )
28.9 (24.6 – 35.4)
32.7 (26.6 – 37.3)
0.00
PHQ2 (+ve)
14 (34.1%)
27 (58.7%)
38 (79.2%)
Pain grade 4
13 (31.7%)
14 (30.4%)
30 (62.5%)
0.01
Medication
2 (1-3)
4 (3-5)
5 (4-8.5)
* one-way ANOVA for any difference
Acknowledgements. This is a summary of independent research funded by the National Institute for Health Research (NIHR)’s In Practice Fellowship Programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Many Thanks to West Midlands Clinical Research Network for their support with this study.
References: (1) Noble, M., Treadwell, J.R., Tregear, S.J., Coates, V.H., Wiffen, P.J., Akafomo, C., Schoelles, K.M. (2010). Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev CD (2) Els, C., Jackson, T., Hagtvedt, R., Kunyk, D., Sonnenberg, B., Lappi, V., Straube, S. (2017a). High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 1–15. (3) O’Brien, T., Christrup, L.L., Drewes, A.M., Fallon, M.T., Kress, H.G., McQuay, H.J., Mikus, G., Morlion, B.J., Perez-Cajaraville, J., Pogatzki-Zahn, E., Varrassi, G., Wells, J.C.D. (2017). European Pain Federation position paper on appropriate opioid use in chronic pain management. Eur J Pain (United Kingdom) 21, 3–19. (4) Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F., Straube, S. (2017b). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev. (5) Kalso, E., Edwards, J.E., Moore, R.A., McQuay, H.J. (2004). Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 112, 372–380. (6) Wersocki, E., Bedson, J., Chen, Y., LeResche, L., Dunn, K. (2017). Comprehensive Systematic Review of long-term opioids in women with chronic non cancer pain and associated reproductive dysfunction (hypothalamic-pituitary-gonadal axis disruption). Pain 158, 8–16. (7) Kriston, L., Günzler, C., Rohde, A., Berner, M.M. (2010). Is One question enough to detect female sexual dysfunctions? a diagnostic accuracy study in 6,194 Women. J Sex Med 7, 1831–1841.