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Personality and psychiatric disorders in chronic pain male affected by erectile dysfunction: prospective and observational study. Int J Impot Res 2020; 33:339-347. [PMID: 32382105 DOI: 10.1038/s41443-020-0294-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/24/2020] [Accepted: 04/16/2020] [Indexed: 11/08/2022]
Abstract
The prevalence of personality disorders (PDs) and sexual dysfunction in chronic pain patients is higher than in general population. Our main objective was to analyse the influence of PD in patients with erectile dysfunction and chronic non-cancer pain and their response to andrological treatment. One-hundred one patients were included along 30 months. Pain intensity, quality of life, sexual life quality, anxiety and depression were analysed together with opioid dose. Erectile functioning was measured with the International Index of Erectile Function (IIEF) and PDs with Millon Clinical Multiaxial Inventory (MCMI-III). The mean age was 57 ± 12 years old, with moderate to severe pain, 70% were sexually active and presented moderate to severe ED. PDs were very frequent (31%, cut-off 85 and 84% cut-off 75 scores) mostly anxiety, compulsive, though disorder, somatoform and narcissistic. Self-defeating feature presence was significantly correlated (r = -0.4, 95% CI = -0.605 to -0.145, p = 0.002) with a more severe baseline ED and narcissistic, and a better response to andrological treatment (p = 0.010, d = 1.082). Patients with dysthymia features required significantly higher opioid doses vs. control (238 vs. 102 mg/day, respectively). These findings underline the importance of diagnosing PDs to rigorously treat patients with chronic pain and ED.
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Bieri M, Said E, Antonini G, Dickerson D, Tuma J, Bartlett CE, Patel AN, Gershman A. Phase I and registry study of autologous bone marrow concentrate evaluated in PDE5 inhibitor refractory erectile dysfunction. J Transl Med 2020; 18:24. [PMID: 31937310 PMCID: PMC6958721 DOI: 10.1186/s12967-019-02195-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/24/2019] [Indexed: 01/09/2023] Open
Abstract
Background Bone marrow mononuclear cells have been successfully utilized for numerous regenerative purposes. In the current study, patients suffering from erectile dysfunction (ED) unresponsive to phosphodiesterase 5 inhibitors were administered autologous bone marrow concentrate delivered intracavernously utilizing a point of care FDA cleared medical device. Methods A total of 40 patients were treated in the primary trial and 100 in the clinical registry, with the longest follow up of 12 months. Results Minimal treatment associated adverse effects where observed related to short term bruising at the site of harvest or injection. No long-term adverse events were noted related to the intervention. Mean improvements in IIEF-5 score were 2 in the Caverstem 1.0 low dose group, 3 in the high dose Caverstem 1.0 group and 9 in the Caverstem 2.0 group. Furthermore, improvements peaked by 3 months and maintained at 6 months follow-up. Conclusion These data support the safety and efficacy of point of care, minimally to non-manipulated, non-expanded bone marrow concentrate for the treatment of ED. Trial registration Funded by Creative Medical Health, Inc.; Clinicaltrials.gov number: NCT03699943; https://clinicaltrials.gov/ct2/show/NCT03699943?term=caverstem&rank=1; initially registered December 12, 2015.
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Affiliation(s)
- Mark Bieri
- Regenerative Health LLC, Las Cruces, NM, USA
| | - Elias Said
- Regenerative Health LLC, Las Cruces, NM, USA
| | | | | | - Jorge Tuma
- Monterrico Clinic & San Felipe Clinic, Lima, Peru
| | | | - Amit N Patel
- University of Utah - Bioengineering, Salt Lake City, UT, USA.
| | - Alexander Gershman
- Institute for Advanced Urology LLC/University of California Los Angeles, Los Angeles, CA, USA
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Bestepe EE, Tunali N, Sarıdoğan GE. Sexual Adverse Effects and Erectile Dysfunction During Buprenorphine/Naloxone Combination Treatment for Opioid Use Disorders. Neuropsychiatr Dis Treat 2020; 16:2695-2705. [PMID: 33209025 PMCID: PMC7669501 DOI: 10.2147/ndt.s276708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/15/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Compliance and maintenance of abstinence is a major issue in substance use disorders. Adverse effects of opioid maintenance treatments (OMT) include sexual dysfunctions. There is a vast amount of studies regarding sexual adverse effects of conventional OMTs; however, information regarding buprenorphine/naloxone (Bup/Nal) combination is limited, mostly evaluated in western populations and controversial. In this study, we aimed to assess the sexual adversities of Bup/Nal treatment in a Turkish alcohol and substance use disorder treatment center sample. MATERIALS AND METHODS We recruited 100 subjects continuing sublingual Bup/Nal combination and 35 control subjects. Subjects were evaluated via the the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) for sexual dysfunction and for erectile dysfunction (ED) with the International Index of Erectile Function-5 (IIEF-5) as a comparison. RESULTS The mean dose of our treatment was 9.05. Overall sexual dysfunction scores were not significantly different in between groups with GRISS. ED and noncommunication scores were significantly higher in the Bup/Nal treatment group than the control group (p = 0.002, p = 0.02, respectively). Along with the increased ED scores in GRISS, IIEF-5 total scores also revealed more significant severity of the ED in the Bup/Nal group (p = 0.001). CONCLUSION Buprenorphine/naloxone combination lead to a higher degree of ED severity than the non-treatment controls. Noncommunication seems to play a role as a risk factor for ED in patients with opioid use disorder. Thus, effective communication can be a key factor for sexual assertivity and disclosing the sexual adverse effects to the clinicians as well as staying in the treatment.
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Affiliation(s)
- Engin Emrem Bestepe
- Department of Psychiatry, Erenkoy Mental Health and Neurological Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nazlı Tunali
- Department of Psychiatry, Erenkoy Mental Health and Neurological Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gökçe Elif Sarıdoğan
- Department of Psychiatry, Erenkoy Mental Health and Neurological Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Harder H, Starkings RM, Fallowfield LJ, Menon U, Jacobs IJ, Jenkins VA. Sexual functioning in 4,418 postmenopausal women participating in UKCTOCS: a qualitative free-text analysis. Menopause 2019; 26:1100-1009. [PMID: 31290761 PMCID: PMC6791508 DOI: 10.1097/gme.0000000000001377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Sexual well-being can contribute significantly to the overall quality of women's lives. This qualitative study aimed to examine sexual activity, functioning, and satisfaction in a large sample of postmenopausal women from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) METHODS:: Thematic analysis was used to evaluate the free-text data of the Fallowfield Sexual Activity Questionnaire (FSAQ) completed by UKCTOCS participants at baseline before annual screening. RESULTS A total of 24,305 women completed the baseline FSAQ and 4,525 (19%) provided free-text data, with 4,418 comments eligible for analysis. Median age was 64 years; 65% had a partner and 22.5% were sexually active. Four interrelated themes were derived: partner availability, physical and sexual health, mental well-being, and interpersonal relationships. Primary reason for absence of sexual activity was lack of a partner, mainly due to widowhood (n = 1,000). Women discussed how partner's medical condition (27%) or sexual dysfunction (13.5%), their own physical health (18%) or menopause-related symptoms (12.5%), and prescribed medication (7%) affected sexual activity. Impact of low libido in self (16%) or partner (7%), relationship problems (10.5%) or logistics (6%), and perceptions of ageing (9%) were also mentioned. Few (3%) referred to positive sexual experiences or had sought medical help for sexual problems (6%). CONCLUSIONS This qualitative analysis explored postmenopausal women's perspective on their sexual functioning. Having an intimate partner and good physical health are key factors for continuation of sexual activity and satisfaction. Further sexual education for healthcare professionals is needed to raise awareness about sexuality and sexual difficulties in later life. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A426.
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Affiliation(s)
- Helena Harder
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Rachel M.L. Starkings
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Lesley J. Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Ian J. Jacobs
- EGA Institute for Women's Health, University College London, London, United Kingdom
- University of New South Wales, Sydney, Australia
| | - Valerie A. Jenkins
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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Kheradmand A, Fazeli A, Mazaheri Meybodi A. Comparing the Effects of Methadone, Buprenorphine, and Opium Tincture Maintenance Therapy on Sexual Function. ADDICTION & HEALTH 2019; 11:120-128. [PMID: 31321009 PMCID: PMC6633070 DOI: 10.22122/ahj.v11i2.232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Opioid use disorder is a major concern to public health, and opioid maintenance treatment on methadone or buprenorphine is a widely used approach. On the other hand, in recent years, there has been more regards for the use of opium tincture for detoxification and maintenance treatment of opioid dependence in certain parts of the world. The purpose of our research was to compare sexual impairments of methadone maintenance treatment (MMT), buprenorphine maintenance treatment (BMT), and opium tincture maintenance treatment (OMT) in patients. Methods The study sample consisted of opium-addicted men candidates for maintenance treatment in an addiction quitting clinic in Tehran, Iran, from November 2017 to February 2018. Participants (n = 84) were randomly assigned to three groups (of the equal number), receiving either methadone tablet, buprenorphine sublingual tablet, and opium tincture. The average score for sexual function was evaluated using the Arizona Sexual Experiences Scale (ASEX) at the beginning and after 3 months after treatment. Findings Although there was no significant different in ASEX scores between the groups at the beginning and end of the study (P > 0.05), but the difference was significant in each group in comparing by themselves. Conclusion These results showed that sexual dysfunction became better after opioid substitution therapies, and no differences were observed on sexual dysfunction between the three groups.
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Affiliation(s)
- Ali Kheradmand
- Taleghani Hospital Research Development Committee AND Department of Psychiatry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahad Fazeli
- Department of Psychiatry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Mazaheri Meybodi
- Taleghani Hospital Research Development Committee AND Department of Psychiatry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Baykara S, Alban K. The effects of buprenorphine/naloxone maintenance treatment on sexual dysfunction, sleep and weight in opioid use disorder patients. Psychiatry Res 2019; 272:450-453. [PMID: 30611963 DOI: 10.1016/j.psychres.2018.12.153] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 12/12/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
Opioid use disorder is a growing social problem. Different agents are used in the treatment of this disorder. One of these agents is buprenorphine / naloxone combination that includes buprenorphine and naloxone in a ratio of 4:1. Although used successfully in opiate maintenance treatment, buprenorphine / naloxone could have some side effects that might affect the treatment. The present study aimed to examine the effects of buprenorphine /naloxone opiate maintenance treatment on sexual dysfunction, sleep and bodyweight in patients diagnosed with opioid use disorder and to draw the attention of clinicians to the adverse effects of the treatment. The study group included 107 inpatients who were diagnosed based on The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and received treatment for opioid use disorder. On admission to the hospital and at the end of the 4th month, a Sociodemographic and Clinical Data Form, the Pittsburgh Sleep Quality Index (PSQI) and the Arizona Sexual Life Scale (ASEX) were applied to all patients. Patients were weighed, and their weight was recorded on the day of admission to the hospital and at the end of the 4th month. The data recorded at the beginning and during the treatment of the same group were compared. The mean age of 107 patients was 24.55 ± 4.27. Overall ASEX scores were 12.98 ± 4.33 before treatment and 15.03 ± 6.61 at 4 months (p < 0.001). The mean patient bodyweight was 63.86 ± 8.78 kg before the treatment and 68.49 ± 8.65 kg at the 4th month of the treatment (p < 0.001). Total PSQI scores were 8.87 ± 3.53 before the treatment and 6.85 ± 3.29 at the 4th month of the treatment (p < 0.001). The study findings demonstrated that after 4 months of buprenorphine /naloxone treatment, total ASEX scores and bodyweight of the patients increased and total PSQI scores decreased. These results demonstrated that sexual problems and bodyweight of the patients increased after the buprenorphine /naloxone treatment and sleep-related problems decreased, albeit still prevalent. These potential side effects should be included with other information about buprenorphine that is given to patients as they may influence interest in starting or continuing treatment.
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Affiliation(s)
- Sema Baykara
- Department of Psychiatry, School of Medicine, Fırat University, Elazig, Turkey.
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Muriel J, Margarit C, Barrachina J, Ballester P, Flor A, Morales D, Horga JF, Fernández E, Peiró A. Pharmacogenetics and prediction of adverse events in prescription opioid use disorder patients. Basic Clin Pharmacol Toxicol 2018; 124:439-448. [DOI: 10.1111/bcpt.13155] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/11/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Javier Muriel
- Neuropharmacology on Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
- Occupational Observatory Miguel Hernández University of Elche Elche Spain
| | - César Margarit
- Neuropharmacology on Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
- Pain Unit Department of Health of Alicante‐General Hospital Alicante Spain
| | - Jordi Barrachina
- Occupational Observatory Miguel Hernández University of Elche Elche Spain
| | - Pura Ballester
- Neuropharmacology on Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
- Occupational Observatory Miguel Hernández University of Elche Elche Spain
| | - Andrea Flor
- Pain Unit Department of Health of Alicante‐General Hospital Alicante Spain
| | - Domingo Morales
- Operations Research Centre Miguel Hernández University of Elche Elche Spain
| | - José F. Horga
- Clinical Pharmacology Unit Department of Health of Alicante‐General Hospital Alicante Spain
| | - Eduardo Fernández
- Biomedical Neuroengineering Research Group (nBio) Systems Engineering and Automation Department of Miguel Hernandez University Elche Spain
| | - Ana M. Peiró
- Neuropharmacology on Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
- Pain Unit Department of Health of Alicante‐General Hospital Alicante Spain
- Clinical Pharmacology Unit Department of Health of Alicante‐General Hospital Alicante Spain
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Zhao S, Deng T, Luo L, Wang J, Li E, Liu L, Li F, Luo J, Zhao Z. Association Between Opioid Use and Risk of Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2017; 14:1209-1219. [PMID: 28923307 DOI: 10.1016/j.jsxm.2017.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/07/2017] [Accepted: 08/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Opioid analgesics have been widely used to relieve chronic pain conditions; however, a connection between opioid analgesic administration and increased susceptibility to erectile dysfunction (ED) has been hypothesized. AIM To evaluate whether opioid use was a risk factor for ED in a systematic review and meta-analysis. METHODS The PubMed, Cochrane Library, and Embase databases were searched to identify eligible studies concerning opioid use and risk of ED from inception to April 2017. The association between opioid use and risk of ED was summarized using the relative risk with 95% CI. Sensitivity analyses were conducted to assess potential bias. The Begg and Egger tests were used for publication bias analysis. The GRADE evidence profile tool was used to assess the quality of the evidence. OUTCOMES The overall combined risk estimates for the effect of opioid use on ED were calculated using a random-effects model. RESULTS This meta-analysis included 8,829 men (mean age = 41.6 years) from 10 studies, 2,456 of whom received opioid management (duration of intervention = 4 months to 9.5 years). Pooled results demonstrated that the use of opioids was significantly associated with an increased risk of ED (relative risk = 1.96, 95% CI = 1.66-2.32, P < .001). Estimates of the total effects were generally consistent in the sensitivity analysis. No evidence of publication bias was observed. The overall quality of evidence was rated as low. CLINICAL IMPLICATIONS We found that men with opioid use had a significantly increased prevalence of ED, which suggests that patients and clinicians should be aware of the potential role played by opioid administration in the development of ED. STRENGTHS AND LIMITATIONS This is the first meta-analysis performed to describe the relation between opioid use and ED risk based on all available epidemiologic studies. However, the direction of causality between opioid use and risk of ED should be interpreted with caution because most included studies used a cross-sectional design. CONCLUSION Evidence from the included observational studies indicated that men with opioid use had a significantly increased risk of ED. Further randomized controlled trials are still needed to confirm this relation. Zhao S, Deng T, Luo L, et al. Association Between Opioid Use and Risk of Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2017;14:1209-1219.
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Affiliation(s)
- Shankun Zhao
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tuo Deng
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lianmin Luo
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiamin Wang
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ermao Li
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Luhao Liu
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Futian Li
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jintai Luo
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhigang Zhao
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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