Opioids for back pain are linked to increased risk of erectile dysfunction

BMJ 2013; 346 doi: (Published 17 May 2013) Cite this as: BMJ 2013;346:f3223
  1. Sophie Ramsey
  1. 1BMJ

Men who take opioid analgesics for back pain over a long period may have an increased risk of erectile dysfunction, a study has found.1Long term opioid use has already been linked with hypogonadism.

To explore the relation between the use of drugs for erectile dysfunction or testosterone replacement and opioid use, researchers looked 11 327 men diagnosed with back pain on at least one visit in 2004. Their mean age was 49 years. The researchers examined the prescriptions on pharmacy and medical records of these men six months before and six months after this visit.

Overall, the analysis found that the probability of receiving drugs for erectile dysfunction or testosterone replacement increased with increasing dose and duration of opioid treatment. Among men who received long term opioids, 19% also received prescriptions for erectile dysfunction or testosterone replacement, compared with 12.5% of men receiving opioids at lower doses and 6.7% of men who had no opioid treatment. Long term opioid use was defined as 120 mg morphine equivalents per day for more than 120 days, or 90 days with more than 10 prescriptions.

After adjusting for the men’s ages and other factors that might affect their risk of erection problems, the researchers estimated that long term use of opioid painkillers was linked to a 45% increase in the chance of erection problems (odds ratio 1.45, 95% confidence interval 1.12 to 1.87; P<0.01). Patients prescribed the highest doses of opioids (≥120 mg of morphine equivalents per day) were 58% more likely to have drug treatment for erectile dysfunction or low testosterone (1.58, 1.03 to 2.43). Depressive disorders (odds ratio 1.3, 95% confidence interval 1.06 to 1.60) and the use of sedatives or hypnotics (1.30, 1.08 to 1.56) were also associated with prescriptions for erectile dysfunction or reduced replacement.

The researchers acknowledge that they do not know if the relation between opioid use and sexual dysfunction is causal, although the dose-response association observed strengthened this argument.

They concluded: “For clinicians, our data provide a reminder that information on sexual dysfunction should be part of clinical decision making with regard to long term pain management and provide some evidence regarding its prevalence. Both patients and clinicians should recognise possible opioid effects on sexual [dysfunction] in considering treatment options.


Cite this as: BMJ 2013;346:f3223