Gender Differences in Depression and Sex Hormones among Patients Receiving Long-Term Opioid Treatment for Chronic Noncancer Pain in Taiwan-A Multicenter Cross-Sectional Study.

Shung-Tai Ho,Kuang-I Cheng,Yeong-Ray Wen,Yen-Chin Liu,Yi-Jer Hsieh,Wei-Zen Sun,Yu-Chuan Tsai,Chun-Sung Sung,Po-Kai Wang,Chun-Chang Yeh,Tso-Chou Lin

doi:10.3390/ijerph18157837

Abstract

Background: Long-term use of opioids for chronic noncancer pain is associated with sex hormone disturbances. The interferences with sex hormones, sexual function, and depression were investigated in patients with chronic noncancer pain. Methods: A cross-sectional multicenter survey was conducted on 170 officially registered outpatients receiving long-term opioid treatment in nine medical centers in Taiwan between October 2018 and July 2019. Serum sex hormone levels were examined after the collection of self-administered questionnaires containing the Taiwanese version of the Brief Pain Inventory, depressive status, and sexual function interference. Results: Among 117 (68.8%) questionnaire responses from 170 enrolled outpatients, 38 women and 62 men completed the sex hormone tests, among whom only 23 (23%) had previously received blood hormone tests. Low serum total testosterone levels were detected in 34 (89.5%) women (<30 ng/dL) and 31 (50%) men (<300 ng/dL). Over 60% of women and men reported reduced sexual desire and function despite a nearly 50% reduction in pain intensity and daily function interference over the previous week after opioid treatment. Women generally had higher risks of a depression diagnosis (p = 0.034) and severe depressive symptoms (p = 0.003) and nonsignificantly lower opioid treatment duration (median 81 vs. 120 months) and morphine milligram equivalent (median 134 vs. 165 mg/day) compared with men. Conclusions: This survey demonstrated the high prevalence of depression diagnosis, low sex hormone levels, and reduced sexual function among Taiwanese patients with chronic noncancer pain receiving prolonged opioid therapy. Regular hypogonadal screenings are recommended for further management.

Highlights

The drastic increase in opioid prescription and prolonged use over the past two decades has led to an “opioid crisis” in the United States, manifested by prescription opioids involved in 32% of opioid-related overdose deaths in 2018 [1]
Depression, sleep disturbance, sexual dysfunction, and resultant psychosocioeconomic factors all participate in the complexity of unintentional overdose of opioids or suicide [5]
After approval was obtained from the relevant institutional review boards (KMUHIRBE(II)-20190028, TSGHIRB-2-106-05-162, NTUH-201810037RINC, TVGHIRB-2018-12-010BC, CMUH-108-REC2-029, CCHIRB-181118, HTCH-IRB107-212-B, NCKUHIRB-B-ER-108-008, and EDAHIRB-EMRP-107-118), adult patients receiving long-term opioid treatment for CNCP in nine medical centers from the northern, middle, southern, and eastern regions of Taiwan were enrolled between October 2018 and July 2019

Summary

Introduction

The drastic increase in opioid prescription and prolonged use over the past two decades has led to an “opioid crisis” in the United States, manifested by prescription opioids involved in 32% of opioid-related overdose deaths in 2018 [1]. Long-term use of opioids contributes to the increased diagnosis and treatment of opioid-induced hypogonadism [2] with clinical presentation of fatigue, depression, sexual dysfunction, and infertility [3]. Depression, sleep disturbance, sexual dysfunction, and resultant psychosocioeconomic factors all participate in the complexity of unintentional overdose of opioids or suicide [5]. Following the physiological decline of serum levels with advancing age, estrogen treatment exhibits benefits for sexual function in postmenopausal women, [6]. Long-term use of opioids for chronic noncancer pain is associated with sex hormone disturbances. The interferences with sex hormones, sexual function, and depression were investigated in patients with chronic noncancer pain. Serum sex hormone levels were examined after the collection of self-administered questionnaires containing the Taiwanese version of the Brief Pain Inventory, depressive status, and sexual function interference. 117 (68.8%) questionnaire responses from 170 enrolled outpatients, 38 women and 62 men completed the sex hormone tests, among whom only 23 (23%) had previously received blood hormone tests.

Objectives

Methods

Discussion

Conclusion