Opioid Abuse Risk 75% Greater In Depressed Patients With Chronic Back Pain

While opioids are frequently used to treat chronic lower back pain, they may not be the best option for those who also suffer from psychiatric disorders, such as anxiety and depression, according to a new study.

When prescribed these powerful medications, chronic back pain sufferers with psychiatric disorders experienced significantly less pain relief and were much more likely to abuse the drugs.
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“High levels of depression and anxiety are common in patients with chronic lower back pain,” said study author Ajay Wasan, MD, professor of anesthesiology and psychiatry at the University of Pittsburgh School of Medicine, in a press release. “Learning that we are able to better predict treatment success or failure by identifying patients with these conditions is significant.”

Wasan and his colleagues conducted a prospective cohort study of oral opioid therapy in 55 chronic low back pain patients with low, moderate, and high levels of depression or anxiety symptoms. Over the 6.5-month study period, patients received morphine, oxycodone, or a placebo for their pain as needed, and recorded their daily pain levels using an electronic diary.

When compared to chronic back pain sufferers with low levels of depression or anxiety, those with high levels of depression or anxiety experienced 50% less pain improvement and 75% more opioid abuse. This group also experienced significantly more opioid side effects as well as a greater intensity of side effects.

These findings suggest that it may be beneficial for health care providers to identify psychiatric disorders before deciding whether to prescribe opioids for chronic back pain.

“Rather than refusing to prescribe opioids, we suggest that these conditions be treated early and preferably before lower back pain becomes chronic,” Wasan said. “For those prescribed opioids, successful treatment of underlying psychiatric disorders may improve pain relief and reduce the chance of opioid abuse in these patients.”

He and his colleagues suggest more research is needed to confirm whether treating psychiatric disorders early in the course of lower back pain could improve pain and function without the use of opioids or other treatments.

—Colleen Mullarkey

Reference

Wasan AD, Michna E, Edwards RR, Katz JN, Nedeljkovic SS, Dolman AJ, et al. Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology. 8 July 2015. [Epub ahead of print]. doi:10.1097/ALN.0000000000000768.