O impacto neuroendocrinológico do uso prolongado de morfina por vias espinal e oral no tratamento da dor crônica / Neuroendocrine and metabolic effect of the treatment of non-cancer pain patients with morphine used through oral or spinal route

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

Abstract: The hypothalamic-pituitary function, the quality of life and the pain severity of 57 non-cancer pain patients treated or not with morphine through the oral or spinal route were prospective analyzed. Twenty were females (18 - 60 yr) and 37, males (18 - 45 yr). Nineteen were treated with 60 to 120mg/day of morphine sulfate trough the oral route (oral group), 19, with 0.2 to 10 mg/day of morphine infusioned into the intrathecal space through a implanted pump (spinal group), and 19, with non-opioid analgesics and adjuvants (control group). Results. Patients treated with morphine developed significant impairment of the libido and more men of the oral group developed reduction of sexual potency than of the control group, more women treated with morphine presented hot flushes than women of the control group, and all women of the spinal group had menstrual cycle dysfunction. More patients treated with morphine presented total serum testosterone levels <271 ng/dL than patients of the control group (p=0.012). Serum basal or stimulated LH and FSH levels, basal ACTH plasma levels, basal and peak cortisol plasma levels, basal serum IGF-I levels, GH serum peak during the insulin tolerance test, 24h free cortisol urinary excretion, serum concentration of thyroid hormones, serum fibrinogen, cholesterol fractions, triglycerides and Lpa levels were not statistically different among the patients included in any of the three study groups. More patients treated with morphine presented reduced DHEAS serum levels and subnormal TSH serum responses stimulated with TRH (p=0.020). More patients treated with morphine presented total cholesterol serum levels >200mg/dL and higher C-reactive protein levels (p=0.03) than those of the control group. The serum 25-OH-vitamin D levels were lower than 30ng/mL in 69% to 94% of the patients in patients belonging to all 3 study groups. More men of the spinal group presented total body BMD bellow normal than patients of the other groups (p=0.014). The prevalence of osteopenia was higher (p=0.01) in the spinal group patients and more patients of the oral group presented osteoporosis (p=0.023) than those of the control group. The bone losses were not related to any hormonal change. Conclusions. Hypogonadotrophic hypogonadism was more prevalent in patients treated with morphine; bone loss was could be related with the use of morphine. GH, TSH, and ACTH axis serum levels were lower and the cardiovascular risk parameters were less frequent in patients treated with morphine. There prevalence of 25-OH-vitamin D deficiency was a high in the patients of all three study groups

ASSUNTO(S)

chronic disease doença crônica implantable pumps for spinal delivery of drugs hormones hormônios morfina bone loss perda óssea dor bombas de infusão implantáveis pain morphine

ACESSO AO ARTIGO

Documentos Relacionados