Psychiatric Disorders Reduce Opioid Efficacy, Increase Abuse Risk

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Patients with comorbid psychiatric disorders, including depression and anxiety, may experience much less pain relief with opioids.
Patients with comorbid psychiatric disorders, including depression and anxiety, may experience much less pain relief with opioids.

Opioids are often prescribed to treat chronic lower back pain, but patients with comorbid psychiatric disorders such as depression and anxiety could experience significantly less pain relief with this therapy and may be more likely to abuse their medication.

In a study published in Anesthesiology, Ajay Wasan, MD, and colleagues conducted a prospective cohort study of 55 chronic lower back pain patients with low-to-high levels of depression or anxiety symptoms. The patients were prescribed oral morphine, oxycodone, or placebo for pain as needed for six months; pain levels and daily doses were recorded by patients.

Patients with high levels of depression or anxiety had 50% less improvement in back pain and were 75% more likely to abuse opioids. They also experienced increased side effects compared to those with low levels of depression or anxiety symptoms.

Wasan stated that these results emphasize the importance of identifying psychiatric disorders prior to opioid therapy as part of a multimodal treatment plan. It is essential to treat conditions early, preferably prior to lower back pain becoming chronic, as successful treatment of psychiatric disorders may boost pain relief and lower the risk of opioid abuse.

Reference

Wasan AD, et al. Psychiatric Comorbidity Is Associated Prospectively with Diminished Opioid Analgesia and Increased Opioid Misuse in Patients with Chronic Low Back Pain. Anesthesiology. 2015; doi:10.1097/ALN.0000000000000768

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