Long-Term Prescription Painkiller Abuse Linked To Erectile Dysfunction

Prescription painkillers have long been used to get relief from moderate to severe pain. However, when used for a long duration, these painkillers have been associated with multiple problems. Some of these health hazards include addiction to the prescription painkiller, overdose of the medicine which can prove fatal, sleep apnea, mood swings, risk of fall especially in elderly people, changes in the levels of various hormones, etc. Now, researchers say that erectile dysfunction in later life can also be added to the long list of problems arising due to long term prescription painkiller abuse.

Researchers from the Kaiser Permanent Center for Health Research tried to find out if there is any association between long term opioid therapy and treatment for erectile dysfunction including testosterone replacement therapy. They analyzed the medical history of 11,327 men from Oregon and Washington who sought the help of their doctors for back ache in 2004. The researchers examined their treatment records for six months before and after the visit to the doctor to see if the patients had been prescribed opioid analgesics or medication for erectile dysfunction. The medication for erectile dysfunction included testosterone replacement.

The prescription painkiller use was classified under five groups

• None meant that the patients were never prescribed opioid analgesics for their back pain.
• Acute for patients who were prescribed prescription painkillers for duration of less than three months.
• Episodic meant that the patients used prescription painkillers for more than three months but less than four months. It also signified that the patients used less than 10 refills of the opioid analgesic.
• Long term use meant that patients took the prescription painkillers for either more than four months of less than three months but more than 10 refills.
• High dose usage was for the consumption of opioid analgesics in excess of 120 mg.

It was observed that when the patients took prescription painkillers in a high dose for at least four months, more than 19% of them had to take treatment for erectile dysfunction or testosterone replacement. Even consuming opioid analgesics in dose less than 120 mg for at least four months resulted in erectile dysfunction in around 12% patients. However, when no prescription painkiller was prescribed to the patients for their back pain, fewer than 7% required medication for erectile dysfunction or testosterone replacement.

The researchers also noted that elderly patients above the age of 60 to 69 years were almost 14 times at a higher risk of developing erectile dysfunction compared to patients from the younger age group of 18 to 29 years.

Although depression, other problems related to health, and use of benzodiazepines for treating insomnia can also lead to erectile dysfunction, researchers found that even after adjusting these confounding factors, long term prescription painkiller abuse is associated with erectile dysfunction in 50% of patients. The results of the study have been published in the journal Spine.

Use Of Prescription Painkillers Has Been Steadily Increasing

It has been seen that the use of opioid analgesics in the treatment of pain has been steadily increasing in the US over the past decades. Between the period of 1999 and 2010, the use of prescription painkillers has almost grown four times, according to the latest Centers for Disease Control and Prevention’s Mortality and Morbidity Report.

Opioid analgesics have been use for providing relief from acute and chronic pain, right from the time of Ancient Greeks. Opioid is originally derived from the latex of the immature seed capsules of the poppy flower. Although there are many different types of analgesics for pain relief, opioid analgesics are considered to be the most effective. They are used by millions of patients worldwide. According to a recent survey which has been published in the journal Pain, opioid medications are used by almost 4.3 million adults in the US on a routine basis.

Opioid painkillers activate the opioid receptors present in the brain. These receptors, in turn, stimulate the release of a neurotransmitter called as dopamine. The latter chemical is responsible for a sense of well-being and happiness. It also dulls the pain signals perceived by the brain. Because of this reason, opioids are frequently abused. The commonly abused prescription painkillers include morphine, hydrocodone and oxycodone.

Apart from long term abuse of prescription painkillers, many other conditions can lead to erectile dysfunction

Erectile dysfunction is a condition in which men either do not achieve an erection at all or are unable to sustain it. Although the condition can arise at any age, it is commonly seen in elderly people. About 50% of men between the ages of 40 and 70 years suffer from erectile dysfunction. The condition steadily increases with the advancing age and around seven of ten men above the age of 70 suffer from this problem.

In most of the men, erectile dysfunction is a transient condition resulting from too much of stress, sleep deprivation or too many drinks. However, sometimes, there may be an underlying pathology. Conditions which lead to erectile dysfunction include:

• Diseases affecting the blood vessels of the penis- Any condition which leads to narrowing of blood vessels of the penis may lead to impaired blood flow resulting in erectile dysfunction. The common culprits include hypertension and hypercholesterolemia. This problem is common in men above the age of 40.
• Diseases affecting the nerve supply of the penis- This type of erectile dysfunction is commonly seen in patients of multiple sclerosis, Parkinson’s disease or stroke.
• Diseases that affect both the blood vessels and nerve supply of the penis- Men suffering from diabetes commonly have erectile dysfunction because of the affliction of both the blood vessels and the nerves supplying the penis.
• Testosterone deficiency- Testosterone deficiency as seen with advancing age may lead to erectile dysfunction. Any head injury which damages the pituitary gland may lead to a decrease in testosterone stimulating hormone which, in turn, leads to impaired production of testosterone from the testes.
• As a side effect of various medicines- Many medicines have been incriminated for causing erectile dysfunction. Some of the common medicines which can cause this condition as a side effect include antidepressants and beta blockers like atenolol, etc. Certain diuretics and antacids like cimetidine are also known to cause erectile dysfunction. And now, based on the results of the latest research, we can say that long term abuse of prescription painkillers may also lead to erectile dysfunction.

Researchers have cautioned that physicians prescribing opioid analgesics for backache and pain relief at other sites should be aware of this side effect.