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Long-term opioid treatment and endocrine measures in chronic non-cancer pain patients: A systematic review and meta-analysis

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@article{fca4fd823bdc4915851ff23c14faaeed,
title = "Long-term opioid treatment and endocrine measures in chronic non-cancer pain patients: A systematic review and meta-analysis",
abstract = "BACKGROUND AND OBJECTIVE: Long-term opioid treatment (L-TOT) of chronic non-cancer pain (CNCP) patients has been suspected to alter the endocrine system. This systematic review and meta-analysis aimed at investigating the published evidence of L-TOT effects on the endocrine system in adult CNCP patients.DATABASES AND DATA TREATMENT: A systematic search of the literature in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and the CINAHL was performed. Studies examining measures of endocrine function of the hypothalamic-pituitary-gonadal, -adrenal, -thyroid, -somatotropic and -prolactin axis in adult CNCP patients in L-TOT (≥4 weeks of use) were included. Outcomes and the level of evidence were analyzed (The Cochrane Collaboration Tool, modified version of the Newcastle-Ottawa Scale and Rating of Recommendations Assessment, Development and Evaluation working group).RESULTS: A total of 2,660 studies were identified; 1981 excluded and finally thirteen studies (one randomized controlled trial (RCT), three longitudinal- and nine cross-sectional studies) were analyzed. L-TOT was associated with low insulin, suppression of the hypothalamic-pituitary-gonadal axis and alterations of the hypothalamic-pituitary-adrenal axis in both men and women with CNCP compared to different control groups (CNCP or healthy pain-free). No other significant differences were reported. The studies had a high risk of bias and the overall quality of evidence was low.CONCLUSION: There seems to be an impact of L-TOT in CNCP patients on several components of the endocrine system, but the level of evidence is weak. Given the high prevalence of L-TOT use systematic studies of larger patient populations are urgently needed.SIGNIFICANCE: This systematic review and meta-analysis suggested that long-term opioid treatment may suppress the hypothalamic-pituitary-gonadal axis, and result in lower insulin levels and alter the glucocorticoid adrenal axis in adult chronic non-cancer pain patients. This adds to the need of more research of both clinical and paraclinical outcomes and their association when initiating and maintaining long-term opioid treatment.",
keywords = "Adult, Analgesics, Opioid/therapeutic use, Cancer Pain, Chronic Pain/drug therapy, Female, Humans, Hypothalamo-Hypophyseal System, Male, Pituitary-Adrenal System, Randomized Controlled Trials as Topic",
author = "Diasso, {Pernille D K} and Benedikte, {Frederiksen S} and Nielsen, {Susanne D} and Main, {Katharina M} and Per Sj{\o}gren and Kurita, {Geana P}",
note = "This article is protected by copyright. All rights reserved.",
year = "2021",
month = oct,
doi = "10.1002/ejp.1797",
language = "English",
volume = "25",
pages = "1859--1875",
journal = "European Journal of Pain",
issn = "1090-3801",
publisher = "W.B./Saunders Co. Ltd",
number = "9",

}

RIS

TY - JOUR

T1 - Long-term opioid treatment and endocrine measures in chronic non-cancer pain patients

T2 - A systematic review and meta-analysis

AU - Diasso, Pernille D K

AU - Benedikte, Frederiksen S

AU - Nielsen, Susanne D

AU - Main, Katharina M

AU - Sjøgren, Per

AU - Kurita, Geana P

N1 - This article is protected by copyright. All rights reserved.

PY - 2021/10

Y1 - 2021/10

N2 - BACKGROUND AND OBJECTIVE: Long-term opioid treatment (L-TOT) of chronic non-cancer pain (CNCP) patients has been suspected to alter the endocrine system. This systematic review and meta-analysis aimed at investigating the published evidence of L-TOT effects on the endocrine system in adult CNCP patients.DATABASES AND DATA TREATMENT: A systematic search of the literature in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and the CINAHL was performed. Studies examining measures of endocrine function of the hypothalamic-pituitary-gonadal, -adrenal, -thyroid, -somatotropic and -prolactin axis in adult CNCP patients in L-TOT (≥4 weeks of use) were included. Outcomes and the level of evidence were analyzed (The Cochrane Collaboration Tool, modified version of the Newcastle-Ottawa Scale and Rating of Recommendations Assessment, Development and Evaluation working group).RESULTS: A total of 2,660 studies were identified; 1981 excluded and finally thirteen studies (one randomized controlled trial (RCT), three longitudinal- and nine cross-sectional studies) were analyzed. L-TOT was associated with low insulin, suppression of the hypothalamic-pituitary-gonadal axis and alterations of the hypothalamic-pituitary-adrenal axis in both men and women with CNCP compared to different control groups (CNCP or healthy pain-free). No other significant differences were reported. The studies had a high risk of bias and the overall quality of evidence was low.CONCLUSION: There seems to be an impact of L-TOT in CNCP patients on several components of the endocrine system, but the level of evidence is weak. Given the high prevalence of L-TOT use systematic studies of larger patient populations are urgently needed.SIGNIFICANCE: This systematic review and meta-analysis suggested that long-term opioid treatment may suppress the hypothalamic-pituitary-gonadal axis, and result in lower insulin levels and alter the glucocorticoid adrenal axis in adult chronic non-cancer pain patients. This adds to the need of more research of both clinical and paraclinical outcomes and their association when initiating and maintaining long-term opioid treatment.

AB - BACKGROUND AND OBJECTIVE: Long-term opioid treatment (L-TOT) of chronic non-cancer pain (CNCP) patients has been suspected to alter the endocrine system. This systematic review and meta-analysis aimed at investigating the published evidence of L-TOT effects on the endocrine system in adult CNCP patients.DATABASES AND DATA TREATMENT: A systematic search of the literature in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and the CINAHL was performed. Studies examining measures of endocrine function of the hypothalamic-pituitary-gonadal, -adrenal, -thyroid, -somatotropic and -prolactin axis in adult CNCP patients in L-TOT (≥4 weeks of use) were included. Outcomes and the level of evidence were analyzed (The Cochrane Collaboration Tool, modified version of the Newcastle-Ottawa Scale and Rating of Recommendations Assessment, Development and Evaluation working group).RESULTS: A total of 2,660 studies were identified; 1981 excluded and finally thirteen studies (one randomized controlled trial (RCT), three longitudinal- and nine cross-sectional studies) were analyzed. L-TOT was associated with low insulin, suppression of the hypothalamic-pituitary-gonadal axis and alterations of the hypothalamic-pituitary-adrenal axis in both men and women with CNCP compared to different control groups (CNCP or healthy pain-free). No other significant differences were reported. The studies had a high risk of bias and the overall quality of evidence was low.CONCLUSION: There seems to be an impact of L-TOT in CNCP patients on several components of the endocrine system, but the level of evidence is weak. Given the high prevalence of L-TOT use systematic studies of larger patient populations are urgently needed.SIGNIFICANCE: This systematic review and meta-analysis suggested that long-term opioid treatment may suppress the hypothalamic-pituitary-gonadal axis, and result in lower insulin levels and alter the glucocorticoid adrenal axis in adult chronic non-cancer pain patients. This adds to the need of more research of both clinical and paraclinical outcomes and their association when initiating and maintaining long-term opioid treatment.

KW - Adult

KW - Analgesics, Opioid/therapeutic use

KW - Cancer Pain

KW - Chronic Pain/drug therapy

KW - Female

KW - Humans

KW - Hypothalamo-Hypophyseal System

KW - Male

KW - Pituitary-Adrenal System

KW - Randomized Controlled Trials as Topic

UR - http://www.scopus.com/inward/record.url?scp=85108250990&partnerID=8YFLogxK

U2 - 10.1002/ejp.1797

DO - 10.1002/ejp.1797

M3 - Review

C2 - 33982828

VL - 25

SP - 1859

EP - 1875

JO - European Journal of Pain

JF - European Journal of Pain

SN - 1090-3801

IS - 9

ER -

ID: 65654229