A new study shows that patients with low back pain who were depressed were more likely to be prescribed opioids and receive higher doses. Understanding these prescribing patterns sheds new light on the current opioid epidemic and may help determine whether efforts to control prescription opioid abuse are effective.
"Our findings show that these drugs are more often prescribed to low back pain patients who also have symptoms of depression and there is strong evidence that depressed patients are at greater risk for misuse and overdose of opioids," said John Markman, M.D., director of the Department of Neurosurgery's Translational Pain Research Program at the University of Rochester Medical Center (URMC) and senior author of the study which appears in PAIN Reports, a journal of the International Association for the Study of Pain.
Low back pain is a leading cause of disability in the U.S., the most common condition for which opioids are a prescribed treatment.
Using data from the Medical Expenditure Panel Survey, a federally-compiled set of large-scale surveys of families and individuals, their medical providers, and employers across the U.S., the researchers compiled opioid prescription data from 2004-2009. This period is important because it coincides with a steep rise the prescription rates of opioids to treat lower back pain. The timeframe of the study also immediately preceded the introduction on a new generation of drugs designed to deter abuse and the implementation of a wide range of policies to address the opioid epidemic and will serve as an important benchmark to evaluate the impact of these efforts.
The researchers found that individuals with low back pain who were positively screened for depression were more than twice as likely to be prescribed an opioid and received more than twice the typical dose of the drug over the course of a year.
The study also points out the need for researchers to more fully understand the risks and benefits associated with prescribing opioids and other forms of pain medications to individuals with low back pain and depression. Low back pain is also the condition most often studied to approve new pain medications.
"Excluding depressed patients may lead clinicians who rely on these studies to underestimate the risks of opioids when they are prescribed for low back pain in routine practice," said Markman.
Additional co-authors of the study include Joyce Smith (lead author), Irena Pesis-Katz, Xueya Cai, and Bethel Powers with the University of Rochester School of Nursing, and Maria Frazer and Rob Fuino with the URMC Translational Pain Research Program. The study was supported with funding from the University of Rochester Clinical and Translational Science Institute.