Opioids Less Effective in Patients with Depression or Anxiety

Opioid analgesics are often prescribed to patients who suffer from chronic lower back pain; however, a new report suggests that these medications are less effective in a subset of these patients.

Psychiatric comorbidities, such as depression or anxiety, are quite common in patients with chronic lower back pain and may predict an increased risk of opioid abuse or reduced opioid effectiveness. To investigate this connection, a collaborative team of researchers studied a cohort of lower back pain patients with low- to-high levels of depression or anxiety symptoms.

“It’s important for physicians to identify psychiatric disorders prior to deciding whether to prescribe opioids for chronic pain as well as treat these conditions as part of a multimodal treatments plan,” said author Ajay Wasan, MD, MSc, a professor of anesthesiology and psychiatry at the University of Pittsburgh School of Medicine, in a news release.

The 6.5-month-long study included 55 patients with chronic lower back pain and varying levels of depression or anxiety. They were prescribed morphine, oxycodone, or a placebo over the course of the trial and recorded their back pain levels and daily dosages.

The report published in the American Society of Anesthesiologists’ journal Anesthesiology indicated a noticeable difference between the groups. Those with high levels of depression or anxiety had a 21% pain improvement while those with lower levels jumped to 39% — a nearly 50% difference.In addition, the high-level patients experienced 75% more opioid abuse when compared to those with lower depression or anxiety levels (39% vs. 8%).

“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,” Watsan explained.

When it comes to approaching patients with psychiatric comorbidities, the authors said that being able to identify those individuals will help when devising a treatment plan. Although the study outcomes indicated that opioids are less effective in those with depression or anxiety, that does not mean that prescriptions should be held from those particular patients. The team advised that the psychiatric conditions be treated early and before the back pain becomes chronic, if possible.

“For those prescribed opioids, successful treatment of underlying psychiatric disorders may improve pain relief and reduce the chance of opioid abuse in these patients,” Wasan confirmed.