The association between depression and type of treatments received for chronic low back pain.
Adolescent
Adult
Analgesics, Opioid
/ adverse effects
Anti-Inflammatory Agents, Non-Steroidal
/ therapeutic use
Chronic Pain
/ drug therapy
Comorbidity
Depression
/ epidemiology
Female
Humans
Logistic Models
Low Back Pain
/ drug therapy
Male
Middle Aged
Pain Management
Primary Health Care
Surveys and Questionnaires
Young Adult
depression
opioid
pain management
primary health care
Journal
Family practice
ISSN: 1460-2229
Titre abrégé: Fam Pract
Pays: England
ID NLM: 8500875
Informations de publication
Date de publication:
23 07 2020
23 07 2020
Historique:
pubmed:
21
11
2019
medline:
11
8
2021
entrez:
21
11
2019
Statut:
ppublish
Résumé
Depression is associated with receipt of opioids in non-cancer pain. To determine whether the receipt of opioid therapy modifies the relationship of depression and use of multiple non-opioid pain treatments. Patients (n = 320) with chronic low back pain (CLBP) were recruited from family medicine clinics and completed questionnaires that measured use of home remedies, physical treatments requiring a provider and non-opioid medication treatments. A binary variable defined use (yes/no) of all three non-opioid treatment categories. Depression (yes/no) was measured with the PHQ-2. The use of opioids (yes/no) was determined by medical record abstraction. Unadjusted and adjusted logistic regression models, stratified on opioid use, estimated the association between depression and use of all three non-opioid treatments. Participants were mostly female (71.3%), non-white (57.5%) and 69.4% were aged 18 to 59 years. In adjusted analyses stratified by opioid use, depression was not significantly associated with using three non-opioid treatments (OR = 2.20; 95% CI = 0.80-6.07) among non-opioid users; but among opioid users, depression was significantly associated with using three non-opioid treatments (OR = 3.21; 95% CI: 1.14-8.99). These odds ratios were not significantly different between opioid users and non-users (P = 0.609). There is modest evidence to conclude that patients with CLBP and comorbid depression, compared with those without depression, were more likely to try both opioid and non-opioid pain treatments. Non-response to other pain treatments may partly explain why depression is associated with greater prescription opioid use.
Sections du résumé
BACKGROUND
Depression is associated with receipt of opioids in non-cancer pain.
OBJECTIVES
To determine whether the receipt of opioid therapy modifies the relationship of depression and use of multiple non-opioid pain treatments.
METHODS
Patients (n = 320) with chronic low back pain (CLBP) were recruited from family medicine clinics and completed questionnaires that measured use of home remedies, physical treatments requiring a provider and non-opioid medication treatments. A binary variable defined use (yes/no) of all three non-opioid treatment categories. Depression (yes/no) was measured with the PHQ-2. The use of opioids (yes/no) was determined by medical record abstraction. Unadjusted and adjusted logistic regression models, stratified on opioid use, estimated the association between depression and use of all three non-opioid treatments.
RESULTS
Participants were mostly female (71.3%), non-white (57.5%) and 69.4% were aged 18 to 59 years. In adjusted analyses stratified by opioid use, depression was not significantly associated with using three non-opioid treatments (OR = 2.20; 95% CI = 0.80-6.07) among non-opioid users; but among opioid users, depression was significantly associated with using three non-opioid treatments (OR = 3.21; 95% CI: 1.14-8.99). These odds ratios were not significantly different between opioid users and non-users (P = 0.609).
CONCLUSION
There is modest evidence to conclude that patients with CLBP and comorbid depression, compared with those without depression, were more likely to try both opioid and non-opioid pain treatments. Non-response to other pain treatments may partly explain why depression is associated with greater prescription opioid use.
Identifiants
pubmed: 31746992
pii: 5634186
doi: 10.1093/fampra/cmz062
pmc: PMC7755115
doi:
Substances chimiques
Analgesics, Opioid
0
Anti-Inflammatory Agents, Non-Steroidal
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
348-354Subventions
Organisme : NCRR NIH HHS
ID : UL1 RR025767
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.
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