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Opioid prescription more likely if patients with back pain are also depressed

By Nicole Mackee 
Patients with low back pain are more likely to be prescribed an opioid if they also have symptoms of depression, US researchers have reported. 

In their US cross-sectional analysis of Medical Expenditure Panel Survey data, published in Pain Reports, the researchers found that higher levels of depressive symptoms – assessed using the Patient Health Questionnaire-2 – were associated with an increased likelihood of a patient being prescribed opioid therapy. 

After adjusting for confounders such as BMI and smoking status, the researchers showed that patients who screened positive for depression were more than twice as likely to be prescribed an opioid (26.2% of patients with depression, compared with 11.4% of patients without). In addition, they received twice the cumulative dose of opioids per year (10,136.0 morphine-equivalent doses in those with depression compared with 4675.5 doses in those without). 

Dr Chris Hayes, Dean of the Australian and New Zealand College of Anaesthetists’ Faculty of Pain Medicine, said the findings added to existing evidence that a patient’s distress during a medical consultation influenced the opioid prescribing rate. 

‘Opioid prescribing is often reflective of a patient’s distress, and that might be linked to depression or anxiety,’ said Dr Hayes, who is also Director of the Hunter Integrated Pain Service (HIPS). However, he said, opioids did not get to the root cause of either pain or depression. 

‘There is certainly some evidence that opioids can aggravate depression in the same way that they can potentially aggravate pain,’ he told Pain Management Today

Dr Hayes noted that pain and depression were common comorbidities, with 47% of patients at HIPS also reporting depression. He said there was likely to be a bidirectional association between pain and depression. 

‘There’s an association in the literature between depression and pain, but it’s not clear that one leads to the other, or vice versa,’ he said, ‘If someone is in pain, that can potentially worsen their depression; if someone is depressed, that can worsen their perception of pain.’

Dr Hayes said taking a broad assessment and treatment approach to low back pain was likely to be more effective than adopting simple, biomedical solutions to pain and depression.

There was good evidence to suggest that physical activity and an anti-inflammatory diet, as well as psychological approaches to calm the nervous system could be of benefit in both chronic pain and depression, he said. 

According to data collected by the Electronic Persistent Pain Outcomes Collaboration, 56% of patients at HIPS who engaged in self-management, behavioural programs targeting pain also made clinically significant gains in depression outcomes. 
Pain Rep 2017; 00: e606; http://dx.doi.org/10.1097/PR9.0000000000000606. 

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