Monday, July 13, 2015

People With Depression, Anxiety May Be Less Responsive to Opioids for Chronic Low Back Pain

Opioids are frequently prescribed to treat chronic low back pain, but new research published online in Anesthesiology suggests these drugs may be less effective and more prone to abuse when taken by someone with anxiety or depression.

Chronic low back pain affects an estimated 50 million adults in the United States, and depression or anxiety are common occurrences in patients in response to the chronic pain. In this study, researchers monitored 81 patients with chronic low back pain and varying degrees of depressive or anxiety symptoms (classified as low, medium, or high) over a six-month period; each patient recorded their pain levels and daily dose of medication.

Despite being prescribed a higher average daily dose of morphine, patients with the highest levels of depression and anxiety reported less improvement in back pain (21% vs. 39% pain improvement), a greater rate of opioid misuse (39% vs. 8%), and significantly more frequent and intense side effects from the morphine compared with patients with low levels of depression and anxiety.

“It's important for physicians to identify psychiatric disorders prior to deciding whether to prescribe opioids for chronic back pain as well as treat these conditions as part of a multimodal treatment plan,” study author Ajay Wasan, M.D., of the University of Pittsburgh School of Medicine said in a press release. “Rather than refusing to prescribe opioids, we suggest that these conditions be treated early and preferably before lower back pain becomes chronic.”

To read more about some of the work being done to prevent opioid misuse, see the Psychiatric News article “House Members Consider Best Options for Treatment, Prevention of Opioid Abuse.”

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