Downside for Men Taking Daily Pain Rx

Low testosterone risk higher in men taking long acting opioids versus short acting opioids

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) An estimated 43 million Americans use pain medicine on a daily basis. Men taking daily doses of pain medicine may experience an unwanted side effect: low testosterone

Opioid medications, like Oxycontin and Vicodin, are prescribed for treating chronic pain. Short-acting opioid medication has an immediate effect and is taken every four to six hours. Long-acting opioids release slowly in the body and are taken every eight to 12 hours. 

Research has documented that taking opioids can cause low testosterone levels. But researchers have not examined the effects of long-acting versus short-acting opioid medications on testosterone levels. 

A recent study found that men taking long-acting opioid medications for pain were nearly five times more likely to have low testosterone levels than those taking short-acting opioids.

"Taking pain Rx? Talk to your pharmacist."

Low testosterone is associated with decreases in bone mass and density, increased pain, depressed mood, thinking impairments and reduced sex drive.

Andrea Rubinstein, MD, of Department for Chronic Pain, Kaiser Permanente, Santa Rosa, California, and colleagues set out to examine testosterone levels of men taking daily long-acting or short-acting opiates for chronic pain.

A total of 81 men with an average age of 51 were referred to Kaiser Permanente's Santa Rosa Medical Center for pain. These 81 men became participants in the study. The men were all on a daily dose of opioids and did not have a previous low testosterone diagnosis. 

Healthy testosterone levels are between 300 to 800 nanograms per deciliter (ng/dl). Low testosterone in this study was defined as a level under 250 ng/dl. 

Results suggested that 74 percent of the participants on long-acting opioids had low testosterone levels, compared to 34 percent of those on short-acting opioids. When the researchers controlled for daily dose and body mass index, the odds of having low testosterone were 4.78 times higher among men taking long-acting opioids. 

"These medications work well for short-term, acute pain," Dr. Rubinstein commented in a press release. "It has long been extrapolated that they can also be used safely long-term to control chronic pain. We are now finding that the long-term use of opioids may have important unintended health consequences."

There were some limitations to the study. The sample size was small and did not allow for specific analysis on specific brands of opiate medication and testosterone level. The participants were referred to the clinic and may not be typical of the general population of opiate users. Symptoms of low testosterone may have been the reason the participant was initially referred to the clinic. 

This study, titled "Hypogonadism in Men With Chronic Pain Linked to the Use of Long-acting Rather Than Short-acting Opioids," was published in The Clinical Journal of Pain. It was funded by Kaiser Permanente. Dr. Rubinstein and co-authors disclosed no conflicts of interest.

Reviewed by: 
Review Date: 
February 6, 2013
Last Updated:
February 7, 2013