Middle aged men with chronic joint pain is one of the largest groups of patients we see. The last thing these men want is a pain medication prescription that will rob them of their already diminishing levels of testosterone. Here at the Magaziner Center for Wellness, we treat low testosterone levels in our chronic pain patients by first getting them off their pain meds.
Research led by doctors at Harvard, the Institute of Aging Research, and the University of Parma, is looking into the side effects chronic pain-killer use (opioid analgesics) are causing men.
The researchers note that androgen deficiency (low testosterone) is common in patients taking opioid analgesics, and testosterone replacement in these men improves libido, quality of life and body composition.
But a concern is would the testosterone raise inflammatory markers in the blood? Are doctors fixing one problem and causing another?
Research has shown aging men see a decline in the necessary hormonal signalling systems that regulate inflammation throughout the body. Introducing testosterone may cause more inflammation as the body would not know how to regulate it. The role of hormones, inflammation, and chronic pain are discussed in our article Low hormone levels and joint pain – the connection is clear.
The Harvard lead team acknowledged this problem and recognized that the effects of testosterone replacement on inflammatory markers in men with chronic pain killer useage had not been evaluated in the literature. So they set about evaluating it.
After a 14-week trial, testosterone administration in men with opioid-induced androgen deficiency was not associated with worsening of metabolic and inflammatory markers.1
The above is important research because testosterone is a very necessary hormone for both men and women for various reasons,including promoting chronic joint pain healing.
But weening patients off of painkillers is sometimes a challenge. Patients can be shown research that Vicodin, OxyContin, Percocet, et al, have a number of adverse effects including hormonal imbalances that hinder successful treatment and recovery from joint disease, 2 yet the need for and possible addiction to the painkillers is tough to overcome.
The hormone painkiller connection was looked at in another study which suggests that hormone levels should be tested for in patients with severe and chronic pain who fail to obtain adequate pain relief with standard pharmacologic treatment agents, including low to moderate dosages of opioids. In the study, the researchers showed four out of 5 patients, for whom opioid pain management failed, demonstrated hormone abnormality.3
A recent article we previously reported on in the Journal of the American Medical Association tells the story of a man whose long term use of painkillers had resulted in low testosterone and a negative impact on his ability to enjoy life.
In this JAMA article – doctors discussed the treatment options available to this man.
- Provide testosterone therapy or painkillers.
The doctors discussed that the man may need the painkillers to function so if given the choice – continue the painkillers and discontinue testosterone replacement as it will not provide clear and clinically important benefit.4 That is the disruptive power of painkillers.
Opioid therapy as a long-term treatment for chronic pain has increased dramatically. Accompanying this upsurge has been an increase in the occurrence of opioid associated endocrinopathy (a disease of the endocrine system), most commonly manifested as an androgen deficiency (low testosterone) and therefore referred to as opioid associated androgen deficiency.
Symptoms that may manifest in patients with OPIAD include:
- reduced libido,
- erectile dysfunction,
- hot flashes,
- and depression.
Physical findings may include:
- reduced facial and body hair,
- decreased muscle mass,
- weight gain, and
- osteopenia or osteoporosis.
According to researchers at Kaiser Permanente regularly taking prescription painkillers is clearly associated with a higher risk of erectile dysfunction.
The research which appeared in the medical journal Spine included more than 11,000 men with back pain and examined their health records to find out if the men taking prescription painkillers were more likely to also receive prescriptions for testosterone replacement or ED medications. 5
More than 19 percent of men who took high-dose opioids for at least four months also received ED prescriptions while fewer than 7 percent of men who did not take opioids received ED prescriptions.
In the study, men over 60 were much more likely to receive ED prescriptions, but even after researchers adjusted for age and other factors, men taking high-dose opioids were still 50 percent more likely to receive ED prescriptions than men who did not take prescription painkillers.5
At the Magaziner Center for Wellness we provide alternative treatments for chronic pain. These include Prolotherapy, Platelet Rich Plasma Therapy, and Stem Cell Therapy, in addition to an “holistic” approach to healing. One of the reasons we focus on this treatment methodology, besides the many years of clinical results in our patients, is that we find these treatments to heal and cure as opposed to “managing” pain.
Our patient population is broad and diverse, from youth and professional athletes to patients well into their golden years who want to remain active, or need to remain active in this volatile economy.
Is testosterone replacement therapy right for you? This is a question best answered after an office visit, some testing, and evaluation of you present health.
Do you have questions about this article?
Call US 856-424-8222 OR email us at: info@DrMagaziner.com
1 Huang G, Travison T, Maggio M, Edwards RR, Basaria S. Effects of Testosterone Replacement on Metabolic and Inflammatory Markers in Men with Opioid-Induced Androgen Deficiency. Clin Endocrinol (Oxf). 2016 Feb 29. doi: 10.1111/cen.13049. [Epub ahead of print]
2. Bawor M, Bami H, Dennis BB, et al. Testosterone suppression in opioid users: a systematic review and meta-analysis. Drug Alcohol Depend. 2015 Apr 1;149:1-9. doi: 10.1016/j.drugalcdep.2015.01.038. Epub 2015 Feb 8.
3. Tennant F. Hormone abnormalities in patients with severe and chronic pain who fail standard treatments. Postgrad Med. 2015 Jan;127(1):1-4. Epub 2014 Dec 15.
5. Smith HS, Elliott JA. Opioid-induced androgen deficiency (OPIAD). Pain Physician. 2012 Jul;15(3 Suppl):ES145-56.
6. Deyo RA, Smith DH, Johnson ES, Tillotson CJ, Donovan M, Yang X, Petrik A, Morasco BJ, Dobscha SK. Prescription opioids for back pain and use of medications for erectile dysfunction. Spine (Phila Pa 1976). 2013 May 15;38(11):909-15. doi: 10.1097/BRS.0b013e3182830482.