Hypogonadism associated with long-term opioid therapy: A systematic review.

BACKGROUND: Sexual dysfunction and Opioid-Induced Sexual Hormone Deficiency (OPISHD) have been associated with patients on long-term opioid pain therapy. There have been few comprehensive reviews to establish a relation between hypogonadism with chronic opioid pain management. The OPISHD is often not treated and literature guiding this topic is scarce. OBJECTIVE: To investigate hypogonadism associated with long-term opioid therapy based on qualitative data analysis of the available literature. STUDY DESIGN: Systematic review. INTERVENTIONS: The review included relevant literature identified through searches of PubMed, Cochrane, Clinical Trials, US National Guideline Clearinghouse, and EMBASE, for the years 1960 to September 2013. The quality assessment and clinical relevance criteria used were the Cochrane Musculoskeletal Review Group Criteria for randomized control trials and the Newcastle-Ottawa Scale Criteria for observational studies. The level of evidence was classified as good, fair, and poor, based on the quality of evidence. MAIN OUTCOME MEASURES: The primary outcome measures were clinical symptoms and laboratory markers of hypogonadism. Secondary outcome measure was management of OPISHD. RESULTS: Thirty-one studies were identified, of which 14 studies met inclusion criteria. There were no randomized control trials and eight of 14 studies were of moderate quality. The remaining studies were of poor quality. Four studies report most patients on long-term oral opioid therapy have associated hypogonadism and three studies of patients receiving intrathecal opioid therapy suggest that hypogonadism is common. CONCLUSIONS: There is lack of high-quality studies to associate chronic opioid pain management with hypogonadism. At present, there is fair evidence to associate hypogonadism with chronic opioid pain management, and only limited evidence for treatment of OPISHD.

Prevalence of temporomandibular disorders in fibromyalgia and failed back syndrome patients: a blinded prospective comparison study.

OBJECTIVES: The objective of this study was to determine the prevalence of temporomandibular disorders (TMD) and evaluate psychosocial domains in patients with fibromyalgia (FM) compared with patients with failed back syndrome (FBS). STUDY DESIGN: The study included 51 (32 FM and 19 FBS) adult patients who were administered orofacial pain and psychological questionnaires before a clinical examination. Presence of TMD was diagnosed according to the Research Diagnostic Criteria for TMD. RESULTS: Fifty-three percent of the FM patients reported having face pain compared with 11% of the FBS patients. Of those FM patients who reported face pain, 71% fulfilled the criteria for a diagnosable TMD. FM patients had significantly higher subscale scores for somatization, obsessive-compulsive, medication used for sleep, and fatigue compared with FBS patients. Eighty-seven percent of the FM patients reported a stressful event and 42.3% had symptoms indicating posttraumatic stress disorder. CONCLUSION: The high prevalence of TMD and psychosocial dysfunction among FM patients suggests wide-reaching dysregulation of autonomic and hypothalamic-pituitary-adrenal axis functions.

An exploratory examination of an academic PM&R inpatient consultation service.

PURPOSE: This study sought to examine an inpatient consultation service delivery system at an academic teaching hospital. METHOD: Descriptive; retrospective; exploratory. Data from a 33 month period were analysed. Demographic profiles of patients receiving consultation were examined. A comparison was also made between alternate methods of delivering physiatric consultation. RESULTS: Only 80% of patients admitted to a teaching hospital during the study period received consultation. Referrals increased by 75% with the institution of a full-time consultation practice model. CONCLUSIONS: The utilization of an inpatient consultation service appears to be dependent upon the service delivery format. Further studies are needed to understand referral patterns and specific challenges to consultation services in an academic setting. Future research should focus on comparing clinical outcomes for patients in diagnostic categories who do and do not receive physiatric consultation.