This review summarises the major effects of opioids on the endocrine system, outlining the long-term effects of their use, which can include reduced libido and sexual function, infertility, mood disorders and bone demineralisation. Although the effects of opioids on the endocrine system are relatively common they might not be detected as many patients do not report these symptoms, thus specific questioning regarding the endocrine effects needs to guide clinical monitoring. The patients most at risk of these toxicities are probably those taking over 100 mg of morphine equivalent daily in the long term. If the patient on opioids has hypogonadism, diagnosing it as opioid-related can be challenging as pain, comorbidities, other medications and age can also influence endocrine function. If it is the opioid causing the endocrine dysfunction, management options include optimisation of non-opioid analgesics which may enable reducing or cessation of the opioid, changing to a different opioid, and hormone supplementation.
Albrecht JS, McGregor JC, Fromme EK, Bearden DT, Furuno JP.
This study from the USA used data from the 2007 National Home and Hospice Care Survey, to estimate the use of antibiotics in the last week of life in 3884 patients who died in hospice care. During this time 27% of hospice patients received at least one antibiotic and 85% of these patients had no documented infectious diagnosis. The authors suggest that further research is needed to elucidate the role of antibiotics in patient in the last week of life to reduce the use of unnecessary antibiotics while maintaining goals care at the end of life.
Am J Med. 2013 Mar;126(3S1):S12-S18.
J Pain Symptom Manage. 2013 Jan. [Epub ahead of print]
Ryan T, Ingleton C, Gardiner C, Parker C, Gott M, Noble B.
In this prospective study which had complete data sets on 514 hospital inpatients, the gold standards framework was used to identify the 185 patients who met palliative care criteria. This cohort had increased physical, psychological and social burden. The most prevalent physical symptoms were tiredness (35%), pain (31%) and weakness (29%) whereas low mood (20%) and anxiety (16%) were the most prevalent psychological symptoms. Only 8% had specialist palliative care input and these were mostly patients with cancer. Dementia was a predictor of physical (OR 3.94) and psychological burden (OR 2.88), and being female was a predictor of psychological burden (OR 2.00). This study indicates that a large proportion of patients with high symptom burden are not receiving specialist palliative care especially patients with non-malignant illnesses, including dementia, who may experience high levels of symptoms.
BMC Palliat Care. 2013 Feb 26;12:11.
Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, Macleod MR, Fallon MT.
This systematic review with a meta-analysis included 28 prospective articles (7101 subjects) which assessed the prevalence of pain syndromes in multiple sclerosis (MS) both cross-sectionally at key milestones, and longitudinally during the MS disease course. The pooled overall pain prevalence (17 studies, 5319 subjects) was 63%, although this estimate contained unexplained heterogeneity. Individual pains were also explored with 43% having headache, 26% neuropathic extremity, 20% back pain, 15% painful spasms, 16% Lhermitte sign, and 4% had trigeminal neuralgia. Cross-sectional prevalence of pain prior to the onset of MS, at onset, and at relapse, and longitudinally were poorly described. It was concluded that although pain and specific pain syndromes are common in MS, the clinical associations and natural history of pain in MS require clarification in future studies.
Pain. 2012 Dec. [Epub ahead of print]
By Jason Boland