Men with chronic pain and opioid-induced androgen deficiency may find some pain relief with testosterone replacement therapy

Men with chronic pain and opioid-induced androgen deficiency may find some pain relief with testosterone replacement therapy

"Androgen deficiency can be a problem in both men and women with chronic pain because opioids suppress the hypothalamic-pituitary-gonadal axis. In men, testosterone levels can be reduced to the castrated range.

The idea to use testosterone replacement therapy to improve pain perception and tolerance in men with opioid-induced androgen deficiency is supported by studies of castrated animals, which have shown that the administration of testosterone alleviates pain. Also, women are generally affected more than men by acute and chronic pain"

"Mechanical pain was assessed with 10 consecutive stimuli applied with a probe to the forearm. At the 10th stimulus -- when the patient would be feeling the most pain -- -- there was a significant improvement in pain tolerance in the testosterone group relative to the placebo group.

Cold tolerance was unaffected by treatment, but the pressure pain threshold was significantly improved in the testosterone group"

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Pain Killers Lower Testosterone: Opioid-Induced Androgen Deficiency (OPIAD)

Accompanying the upsurge in the use of long-term opioid therapy has been an increase in the occurrence of opioid associated endocrinopathy, most commonly manifested as an androgen deficiency and therefore referred to as opioid associated androgen deficiency (OPIAD). Smith HS, Elliott JA. Opioid-Induced Androgen Deficiency (OPIAD). Pain Physician 2012;15(3 Suppl):ES145-56. http://www.painphysicianjournal.com/2012/july/2012;15;ES145-ES156.pdf Opioid therapy is one of the most effective forms of analgesia currently in use. In the past few decades, the use of opioids as a long-term treatment for chronic pain has increased dramatically. Accompanying this upsurge in the use of long-term opioid therapy has been an increase in the occurrence of opioid associated endocrinopathy, most commonly manifested as an androgen deficiency and therefore referred to as opioid associated androgen deficiency (OPIAD). This syndrome is characterized by the presence of inappropriately low levels of gonadotropins (follicle stimulating hormone and luteinizing hormone) leading to inadequate production of sex hormones, particularly testosterone. Symptoms that may manifest in patients with OPIAD include reduced libido, erectile dysfunction, fatigue, hot flashes, and depression. Physical findings may include reduced facial and body hair, anemia, decreased muscle mass, weight gain, and osteopenia or osteoporosis. Additionally, both men and women with OPIAD may suffer from infertility. While the literature regarding OPIAD remains limited, it is apparent that OPIAD is becoming increasingly prevalent among chronic opioid consumers but often goes unrecognized. OPIAD can have a significant negative impact on the the quality of life of opioid users, and clinicians should anticipate the potential for its occurrence whenever long-term opioid prescribing is undertaken. Once diagnosed, treatment for OPIAD may be offered utilizing a number of androgen replacement therapy options including a variety of testosterone preparations and, for female patients with OPIAD, dehydroepiandrosterone (DHEA) supplementation. Follow-up evaluation of patients receiving androgen replacement therapy should include a review of any unresolved symptoms of hypogonadism, laboratory evaluation, and surveillance for potential adverse effects of androgen replacement therapy including prostate disease in males.