Hormone Replacement Therapy and Opioid Tapering for Opioid-Induced Hypogonadism Among Patients with Chronic Noncancer Pain: A Systematic Review

Mahmood AminiLari; Priya Manjoo; Samantha Craigie; Rachel Couban; Li Wang; Jason W Busse

doi:10.1093/pm/pny040

Hormone Replacement Therapy and Opioid Tapering for Opioid-Induced Hypogonadism Among Patients with Chronic Noncancer Pain: A Systematic Review

Pain Med. 2019 Feb 1;20(2):301-313. doi: 10.1093/pm/pny040.

Authors

Mahmood AminiLari^{1

2}, Priya Manjoo³, Samantha Craigie², Rachel Couban², Li Wang⁴, Jason W Busse^{1

2

4}

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
² The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
³ Department of Endocrinology, University of British Columbia, Victoria, British Columbia, Canada.
⁴ Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.

PMID: 29727002
DOI: 10.1093/pm/pny040

Abstract

Objective: To systematically review evidence addressing the efficacy of testosterone replacement therapy (TRT) and opioid tapering for opioid-induced hypogonadism among patients with chronic noncancer pain.

Study design: Systematic review of randomized controlled trials (RCTs) and observational studies.

Methods: We searched MEDLINE, CINAHL, AMED, CENTRAL, CINAHL, DARE, EMBASE, and PsycINFO through August 2017. Eligible studies enrolled ≥10 patients with chronic noncancer pain and opioid-induced hypogonadism and reported the effect of TRT or opioid tapering on a patient-important outcome collected ≥14 days after treatment. Pairs of reviewers independently screened for eligible studies, assessed risk of bias, and extracted data. We used the GRADE approach to rate quality of evidence.

Results: Of 666 abstracts reviewed, five studies including one RCT (N = 84) and four observational studies (N = 157) were eligible. No studies explored the effect of opioid tapering for opioid-induced hypogonadism. Very low-quality evidence found that TRT was associated with improvements in pain (median reduction of 2 points on the 11-point numerical rating scale for pain; 95% confidence interval [CI] = -1.4 to -2.6; minimally important difference [MID] = 2 points), and emotional functioning (mean increase of 9 points on the 100-point SF-36 Mental Component Summary score; 95% CI = 4.40 to 13.60; MID = 5 points). Low-quality evidence suggested that TRT had no effect on sleep quality, sexual function, physical functioning, role functioning, or social functioning; very low-quality evidence suggested no association with depressive symptoms.

Conclusions: Low-quality to very low-quality evidence suggests that TRT may improve pain and emotional functioning, but not other outcomes, in chronic noncancer pain patients with opioid-induced hypogonadism.

Keywords: Chronic Noncancer Pain; Opioid-Induced Hypogonadism; Testosterone.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Analgesics, Opioid / administration & dosage*
Chronic Pain / drug therapy*
Hormone Replacement Therapy / methods*
Humans
Hypogonadism / chemically induced*
Hypogonadism / drug therapy
Male
Testosterone / therapeutic use

Substances

Analgesics, Opioid
Testosterone