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

Autor(es)

Valverde-Filho, Joao ^{[1, 2]} ; Carneiro da Cunha Neto, Malebranche Berardo ^{[1, 2]} ; Fonoff, Erich Talamoni ^{[1, 2]} ; Meirelles, Eduardo de Souza ^[3] ; Teixeira, Manoel Jacobsen ^{[1, 2]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Med, Dept Neurol, Pain Ctr, Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Sch Med, Div Funct Neurosurg, Sao Paulo, SP - Brazil

^[3] Univ Sao Paulo, Sch Med, Dept Radiol, Inst Orthoped & Traumatol, Hosp Clin, Sao Paulo, SP - Brazil

• Tipo de documento: Artigo Científico
• Fonte: PAIN MEDICINE; v. 16, n. 4, p. 715-725, APR 2015.
• Citações Web of Science: 5

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. (AU)

• Processo FAPESP: 11/08529-5 - Estudo controlado e duplamente encoberto sobre o efeito do ozônio aplicado por endoscopia espinhal no tratamento da síndrome dolorosa pós-laminectomia: análise na dor neuropática e não neuropática e sua correlação com o nível de citocinas epidurais
• Beneficiário: Erich Talamoni Fonoff
• Modalidade de apoio: Auxílio à Pesquisa - Regular