Chronic Spinal and Oral Morphine-Induced Neuroendocrine and Metabolic Changes in Noncancer Pain Patients

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Arquivos
art_VALVERDE-FILHO_Chronic_Spinal_and_Oral_MorphineInduced_Neuroendocrine_and_Metabolic_2015.PDF (267.84 KB)
Citações na Scopus
27
Tipo de produção
article
Data de publicação
2015
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY-BLACKWELL
Autores
VALVERDE-FILHO, Joao
Citação
PAIN MEDICINE, v.16, n.4, p.715-725, 2015
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
ObjectiveInteractions between opioid use and hormonal function are documented in the literature. However, it is unclear if therapeutic intrathecal opioid therapy can induce hormonal changes, compared to oral opioid therapy. MethodsThe authors studied hormone and metabolic changes in 22 women (18-60 years) and 38 men (18-45 years) who were referred to a pain center. The patients were allocated to different treatment groups (based on assistant physicians' decision), as follows: 20 patients received oral morphine (60-120 mg/day); 20 patients, spinal morphine (0.2-10 mg/day); and 20 patients, nonopioid analgesic treatment. ResultsAll three groups experienced substantial improvement in pain scores during the whole follow-up period. Significantly impaired libido, reduced potency, hot flashes, and menstrual cycle dysfunction occurred more often in both morphine groups than in the nonopioid group. Significantly low serum total testosterone levels were more prevalent in the spinal morphine group and the oral morphine group (58.3% and 70.0%, respectively) than in the control group (16.7%). Total cholesterol values above 200 mg/dL and higher ultrasensitive C-reactive protein levels were significantly more frequent in the morphine groups than in the controls. Total body bone mineral density was below normal in men receiving spinal morphine (P = 0.014). ConclusionsHypogonadotrophic hypogonadism was more prevalent in the morphine groups and was correlated with clinical findings. Significant bone mass loss occurred in morphine users, even without hormone dysfunction when compared to nonopioid treatment. Growth hormone, thyroid stimulating hormone, adrenocorticotrophic hormones, and cardiovascular risk parameters were less compromised in morphine users.
Palavras-chave
Bone Loss, Chronic Noncancer Pain, Hormones, Intrathecal Therapy, Opiates
URI
https://observatorio.fm.usp.br/handle/OPI/9805
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MNE
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/IOT
Artigos e Materiais de Revistas Científicas - HC/IPq
Artigos e Materiais de Revistas Científicas - LIM/26
Artigos e Materiais de Revistas Científicas - LIM/41