The association between depression and type of treatments received for chronic low back pain

Fam Pract. 2020 Jul 23;37(3):348-354. doi: 10.1093/fampra/cmz062.

Abstract

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.

Keywords: depression; opioid; pain management; primary health care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Chronic Pain / drug therapy*
  • Chronic Pain / epidemiology
  • Comorbidity
  • Depression / epidemiology*
  • Female
  • Humans
  • Logistic Models
  • Low Back Pain / drug therapy*
  • Low Back Pain / epidemiology
  • Male
  • Middle Aged
  • Pain Management
  • Primary Health Care
  • Surveys and Questionnaires
  • Young Adult

Substances

  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal