Increasing Neck Pain, Low Libido, Weight Gain – Maybe Your Opioid Medication Is to Blame?

low testosterone opioids and chronic neck pain

Symptoms of chronic pain or signs of OPIAD?

The sharp rise in the use of opioids for pain management in recent years has also led to an increase in opioid induced androgen deficiency. However, awareness of this condition remains poor and so many patients with chronic neck pain are suffering with symptoms of low libido, weight gain, fatigue, and depression that may be treatable with androgen replacement therapy. Is low testosterone to blame for your symptoms? Are your pain medications to blame for your low testosterone?

Improving Symptoms of Chronic Illness with Testosterone Therapy

Results of a study presented at the ENDO 2013: the Endocrine Society 95th Annual Meeting in June suggest that patients with opioid induced androgen deficiency (OPIAD) may be able to reduce both pain and reliance on pain medications through androgen replacement therapy. Men suffering from testosterone deficiency brought on by chronic use of opioids were given a transdermal gel to use for three months in order to boost testosterone, with the results showing that this helped improve pain tolerance compared to placebo.

Androgens and Signs of Deficiency

Testosterone deficiency has also been seen to affect pain response in animal studies with supplementation increasing rats’ capacity to tolerate pain. This is the first human study showing similar effects and it may help highlight the increasing prevalence of insufficient androgen production in patients with chronic pain conditions.

Androgens are sex hormones, including testosterone, that rely on sufficient levels of gonadotropins (follicle stimulating hormone and luteinizing hormone) to be produced. Gonadotropins can be adversely affected by opioids, leading to lower levels of sex hormone production and symptoms of low testosterone. Both men and women can suffer the effects of OPIAD with symptoms including:

  • Reduced libido
  • erectile dysfunction
  • fatigue
  • hot flashes
  • depression
  • reduction in facial and body hair
  • anemia
  • decreased muscle mass
  • weight gain
  • osteopenia or osteoporosis
  • infertility

Diagnosing OPIAD in Patients with Chronic Pain

Low testosterone connected to long-term opioid use in conditions such as neck pain is not always easy to spot. This is because many of the physical and emotional effects of chronic degenerative spine diseases, as well as the after-effects of neck trauma or neck surgery, can appear similar to symptoms of low levels of circulating androgens. Patients may feel that their symptoms are a normal response to a traumatic experience or a chronic illness and simply not report them to their physician. Many physicians may lack knowledge of OPIAD and, unfortunately, dismiss patients’ symptoms as a typical set of effects connected to chronic ill health.

Dismissing Symptoms of OPIAD

When neck pain affects a person’s ability to exercise, work, and socialize, it may be seen as inevitable that that person will become depressed, overweight, and have issues with their libido and energy levels. That this is not always the case has, however, been illustrated by a study published just last week that found that men taking opioids for back pain were about 50% more likely to fill out a prescription for drugs for erectile dysfunction than men with back pain who were not taking opioid medications.

OPIAD in women

Testing and Treating Androgen Deficiency

Patients are unlikely, and ill-advised to simply cease taking pain medications to see if their symptoms of OPIAD improve. Luckily, blood tests can determine if free and total testosterone levels are abnormally low and patients may then be offered androgen replacement therapy to address the issue. Increasingly, physicians are encouraged to monitor patients taking opioids long-term for signs of OPIAD and to work with patients to prevent severe symptoms arising. Women with OPIAD will likely be prescribed dehydroepiandrosterone (DHEA) while men will be prescribed testosterone to restore functional sex hormone levels and, according to this latest research, this may also help improve pain tolerance and allow them to reduce their use of opioids.

Risks and Benefits of Androgen Replacement Therapy

There are some risks of androgen replacement therapy, however, such as prostate disease in men and so patients are not recommended to pursue self-treatment with DHEA or testosterone using store bought products or medications purchased over the internet. Careful monitoring by a qualified physician needs to be carried out to reduce risks and manage symptoms. The use of androgen replacement therapy has not been well studied in women and benefits may be marginal with some potential side effects including hirsutism, acne, polycythaemia, increased high-density lipoproteins and risk of cardiovascular disease, and endometrial hyperplasia. However, some benefits that have been reported include: improved libido, increasing initiation and enjoyment of sex, and enhanced ability to reach orgasm. Patients in this latest study also reported improvements in emotional symptoms affecting their daily quality of life.

Those suffering with neck pain who have found that opioid pain medications are decreasingly effective at managing their pain and who are experiencing symptoms that may indicate opioid induced androgen insufficiency are encouraged to discuss their concerns with their doctor.


ENDO 2013: the Endocrine Society’s 95th Annual Meeting. Abstract LB-FP-6, presented June 15, 2013.

Smith HS, Elliott JA. Opioid-induced androgen deficiency (OPIAD). Pain Physician. 2012 Jul;15(3 Suppl):ES145-56.

Deyo, R.A., Smith, D.H., Johnson, E.S., Tillotson, C.J., Donovan, M., Yang, X., Petrik, A., Morasco, B.J., Dobscha, S., Prescription Opioids for Back Pain and Use of Medications for Erectile Dysfunction,

Spine, Volume 38 – Issue 11 – p 909–915.

Eden, K.J., and Wylie, K.R. (2009). Quality of sexual life and menopause. Women’s Health, 5 (4), 385-396.

Nappi, R.E. et al., (2006). Clitoral stimulation in postmenopausal women with sexual dysfunction: A pilot randomized study with hormone therapy. European Menopause Journal, 55, 288-295

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