The association between depression and type of treatments received for chronic low back pain. (20th November 2019)

• Record Type: Journal Article
• Authors: Zubatsky, Max; Witthaus, Matthew; Scherrer, Jeffrey F; Salas, Joanne; Gebauer, Sarah; Burge, Sandra; Schneider, F David
• Is Part Of: Family practice. Volume 37:Number 3(2020)
• Page Start: 348
• Page End: 354
• Publication Date: 2019-11-20
• Subjects: depression -- pain management -- opioid -- primary health care; Primary care (Medicine) -- Periodicals; Clinical medicine -- Periodicals; 616.005
• DOI: 10.1093/fampra/cmz062
• Languages: English
• ISSNs: 0263-2136

Abstract

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.