Opioids are less effective in depressed and anxious patients

by Bruce Sylvester: Patients  with  depression or anxiety who were prescribed opioids for chronic lower back pain have achieved significantly less pain relief and were more likely to abuse their medication than similar patients without the psychiatric disorders.

“High levels of depression and anxiety are common in patients with chronic lower back pain,” said author Ajay Wasan, M.D., professor of anesthesiology and psychiatry at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania “Learning that we are able to better predict treatment success or failure by identifying patients with these conditions is significant. This is particularly important for controlled substances such as opioids, where if not prescribed judiciously, patients are exposed to unnecessary risks and a real chance of harm, including addiction or serious side effects.”

Dr. Wasan and his team enrolled 55 chronic lower back pain patients with low- to-high levels of depression or anxiety. Subjects received daily, as-needed doses of morphine, oxycodone or a placebo for  six-months. The subjects recorded daily their pain levels and doses.

The investigators reported that subjects with high levels of depression or anxiety achieved 50 percent less improvement in back pain (21 percent vs. 39 percent pain improvement) and 75 percent more opioid abuse (39 percent vs. 8 percent), compared to patients with low levels of depression or anxiety symptoms.

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