ODP346 Prevalence and Predictors of Endocrinopathies Amongst Patients on Chronic Opioid Use for Non-Cancer Pain
Authors: Ooi Xin Y , Aziz Nurul Izzah , Lim Lee Ling , Paramasivam Sharmila , Vethakkan Shireene , Chan SIew Pheng , Suhaimi Anwar , Ratnasingam Jeyakantha 
Published: November 2022

Abstract

Introduction
Opioids are increasingly used for non-cancer pain control. Studies in cancer patients have shown that chronic opioid use could lead to secondary hypocortisolism and hypogonadism of varying degree. We seek to determine this association in an Asian cohort of patients with non-cancer pain and also examine the effect of opioids on other pituitary hormones comparing them to patients who are on non-opioid analgesia.

Methods
This is a cross-sectional study of patients recruited from pain clinic. Inclusion criteria were patients aged between 18-75 with non-cancer pain on opioids (morphine/oxycodone/fentanyl/tramadol) for more than 3 months. Patients with active cancer or intracranial pathology, who were already on hormone replacement and on long term glucocorticoids or had intra-muscular or intra-articular steroids in the preceding 3 months were excluded. Controls were age and sex matched. All recruited patients had a renal profile, albumin, cortisol, ACTH, fT4, TSH, FSH, LH, IGF-1, prolactin, testosterone (male) and oestrogen (female) drawn at 8am in a fasting state. Demographic data, menstrual history, pain type and pain score, opioid type and duration of use, were collected.

Results
Forty eight patients (28 opioid group and 20 controls), 52% men, 31%postmenopausal women, mean age: 55 ±13 years and mean BMI: 27±5 kg/m 2, were recruited. Opioid group had significantly higher pain score (6±2 vs 5±2, p=0. 09) and duration of pain (6.16 ± 5.87 vs 3.56 ± 3.35 years, p=0. 07) compared to controls. 75% of patents were on short acting opioids with a morphine equivalent daily dose (MEDD) of 31 ± 16 mg. There was a higher prevalence of hypocortisolism in the opioid group (50%) compared to control (30%). Of note, 14% of the opioid group had AM cortisol of &lt;100nmol/L, which required replacement. The MEDD of more than 25mg was the only independent predictor of hypocortisolism with OR: 20.4 (95% CI: 1.1-39. 0, p=0. 04). 11% of patients (3 men, 2 post-menopausal women) had secondary hypogonadism. Pain score was significantly higher (7.8±1.5 vs 5.6±2.1, p=0. 03) and the duration of opioid was significantly longer (7.6±3 vs 3.2±4, p=0. 02) in the hypogonadism group. However, there was no independent predictive factor for hypogonadism. The was no sodium abnormality or other pituitary axes involvement in both groups.

Conclusion
With the increasing use of opioids for non-cancer pain, the prevalence of opioid endocrinopathies are expected to rise. Development of hypocortisolism is independently associated with a higher MEDD. Gonadal axis involvement was more common amongst men and postmenopausal women. Higher use of short acting opioids in our cohort may explain the lower prevalence of hypogonadism compared to previous studies. Further long term studies are needed to examine the need for and effects of hormone replacement in this group of patients.
Presentation: No date and time listed