Home' Australian Pharmacist : February 2013 Contents 66
Australian Pharmacist February 2013 I ©Pharmaceutical Society of Australia Ltd.
The patient was referred to a pain clinic for
review, and was awaiting a consultation at
the time of writing.
This case highlights how an incidental piece
of evidence obtained during a HMR interview
may assist in identifying a previously
unrecognised adverse drug effect that is
significantly impacting upon a patient’s
quality of life. Moreover, opioid-induced
hypogonadism is under-recognised and
undertreated.14,15 The increasing use of
chronic opioid therapy for non-cancer pain is
likely to result in a greater prevalence of cases
such as these.13 Pharmacists performing
HMRs in patients taking long-term opioids
should be aware of this adverse effect,
actively ask about the symptoms and be able
to recommend effective management.
1. The high price of pain: the economic impact of persistent pain
in Australia. Sydney: Access Economics Pty Limited for MBF
Foundation in collaboration with the University of Sydney Pain
Management Research Institute; 2007
2. Blyth FM, March LM, Cousins MJ. Chronic pain-related disability
and use of analgesia and health services in a Sydney community.
MJA 2003;179:84–7 .
3. Gilbert AL, Roughead EE, Beilby J, Mott K, Barratt JD. Collaborative
medication management services: improving patient care. MJA
4. Roughead EE, Barratt JD, Gilbert AL. Medication-related problems
commonly occurring in an Australian community setting.
Pharmacoepidemiol Drug Saf 2004;13:83–7 .
5. Stafford AC, Tenni PC, Peterson GM, et al. Drug-related problems
identified in medication reviews by Australian pharmacists. Pharm
World Sci 2009;31:216–23.
6. O’Brien EM, Staud RM, Hassinger AD, et al. Patient-centered
perspective on treatment outcomes in chronic pain. Pain Med
7. Chronic pain: overview. In: Therapeutic Guidelines Analgesic. 6th
ed. Melbourne: Therapeutic Guidelines Limited; 2012.
8. Teh CF, Zaslavsky AM, Reynolds CF, 3rd, Cleary PD. Effect of depression
treatment on chronic pain outcomes. Psychosom Med 2010;72:61–7 .
9. Timonen M, Liukkonen T. Management of depression in adults. Br
Med J 2008;336:435–9 .
10. Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian
Medicines Handbook; 2012.
1. Which ONE of the following
symptoms is MOST likely to occur
in a man with opioid-induced
a. Weight loss.
2. Which ONE of the following
opioids is LEAST likely to cause
11. Kornick CA, Santiago-Palma J, Moryl N, Payne R, Obbens EAMT.
Benefit-Risk Assessment of Transdermal Fentanyl for the Treatment
of Chronic Pain. Drug Safety 2003;26:951–73.
12. Aloisi AM, Pari G, Ceccarelli I, et al. Gender-related effects of
chronic non-malignant pain and opioid therapy on plasma
levels of macrophage migration inhibitory factor (MIF). Pain
13. Smith H, Elliott J. Opioid-induced androgen deficiency. Pain
14. De Maddalena C, Bellini M, Berra M, Meriggiola MC, Aloisi AM.
Opioid-induced hypogonadism: why and how to treat it. Pain
15. Reddy RG, Aung T, Karavitaki N, Wass JA. Opioid induced
hypogonadism. BMJ 2010;341:c4462.
16. Elliott JA, Opper SE, Agarwal S, Fibuch EE. Non-Analgesic Effects
of Opioids: Opioids and the Endocrine System. Curr Pharm Des
17. Durogesic transdermal system. Product information. Macquarie
Park: Janssen-Cilag Pty Ltd; 2011.
18. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and
side effects. Pain Physician 2008;11:S105–20.
19. Davis MP. Twelve reasons for considering buprenorphine as a frontline
analgesic in the management of pain. J Support Oncol 2012;10:209–19.
20. Schedule of Pharmaceutical Benefits (PBS) Dec 2012. Canberra:
Australian Government Department of Health and Ageing; 2012.
21. Androgen replacement therapy. In: Therapeutic Guidelines:
Endocrinology. Melbourne: Therapeutic Guidelines Pty; 2009.
3. Which ONE of the following
mechanisms is LEAST likely to result
in hypogonadism associated with
a. Blockade of adrenal androgen release.
b. Inhibition of follicle-stimulating
hormone (FSH) and luteinising
hormone (LH) release from the
c. Inhibition of hypothalamic
gonadotropin releasing hormone
d. Increased prolactin secretion.
4. Which ONE of the following
opioid-induced hypogonadism is
a. The symptoms of opioid-induced
hypogonadism generally take several
years to manifest.
b. There is good evidence to routinely
recommend screening of all long-term
opioid users for hypogonadism.
c. The most appropriate treatment for
opioid-induced hypogonadism is oral
d. Opioid-induced hypogonadism
may occur in both sexes but is more
common in male patients.
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1 April 2013 at www.psa.org.au and
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Fax: (04) 381 4786
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