Highlights
- •This study investigated the association between opioid use, pain and depression at a pain clinic.
- •Depression moderated the relation between opioid use, pain severity and physical functioning.
- •In non-depressed patients, opioid use increased as pain increased and functioning decreased.
- •In depressed patients, the probability of taking opioids did not change based on pain or functioning.
- •Unraveling the role of depression in the context of opioid use in clinical settings is a key next step.
Abstract
Depression may be a critical factor in the initiation and maintenance of opioids.
This study investigated the association among opioid use, pain, and depression in
patients evaluated at a university-based outpatient pain clinic. Of the 2,104 new
patients included, 55.89% reported current opioid use and showed a worse phenotypic
profile (eg, higher pain severity, worse physical functioning) compared with nonopioid
users. In addition, more opioid users reported symptoms suggestive of depression than
those not taking opioids (43.6% vs 26.8%, P < .001). In a multivariate logistic regression model, increased pain severity was
associated with increased probability of taking opioids; however, this was moderated
by depression (estimate = −.212, P < .001). For nondepressed patients, the predicted probabilities of opioid use increased
as pain severity increased. In contrast, among patients with symptoms of depression,
the probability of taking opioids did not change based on pain severity. Similarly,
although increased physical function was associated with increased probability of
opioid use, this was moderated by depression (estimate = .033, P = .034). Patients with symptoms of depression were more likely to be taking opioids
at higher levels of functioning (Ps < .03).
Perspective
This study investigated the association among opioid use, pain, and depression at
a university-based outpatient pain clinic. Depression emerged as a moderator of the
relationship among opioid use, pain severity, and physical functioning. These findings
lend support to the hypothesis that patients may be self-medicating affective pain
with opioids.
Key words
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Article info
Publication history
Published online: June 13, 2015
Accepted:
May 28,
2015
Received in revised form:
May 21,
2015
Received:
January 30,
2015
Footnotes
Supported by Pfizer, Forest, Cypress Biosciences, Merck, Nuvo, Cerephex (D.J.C.), ASRA Pain Research Grant (C.M.B. and A.L.H.), and Bristol-Myers Squibb (A.L.H.).
D.J.C. is a current board member of Pfizer, current consultant for Forest, Cypress, Biosciences, Merck, Nuvo, Cerephex, Eli Lilly, Pierre Fabre, Wyeth, UCB, Astra Zeneca, Johnson and Johnson, Jazz, Abbott, Tonix, and Therevance; C.M.B. was funded by Neuros Medical Inc for other research, has a patent (current/no royalties) on Peripheral Perineural Dexmedetomidine, and is a consultant for Tonix Pharmaceuticals; A.L.H. is currently a consultant for Lexicon Pharmaceuticals and Precision Health Economica, a past consultant for Pfizer, Inc and Bristol-Myers Squibb; and has a patent (current/no royalties) on Peripheral Perineural Dexmedetomidine. J.G., S.E.M, M.J.H., and M.R. have no conflicts of interest to report.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
