Even though prescibing opioids to treat patients with chronic lower back pain has been a controversial topic among experts in the pain management community, additional research on how opioids affect patients with mental illnesses may change the way physicians treat pain lasting longer than 12 months.
Published in the Anesthesiology, the journal of the American Society of Anesthesiologists, a new report concluded that patients with psychiatric disorders such as depression or anxiety are more likely to abuse opioids prescribed for chronic lower back pain.1
Researchers additionally learned that these patients experienced significantly less pain relief after ingesting their treatment.
Depression or anxiety patients experienced 50% less improvement in back pain and 75% more opioid abuse.
Fifty-five chronic lower back pain patients with low to high levels of anxiety or depression systems participated in the cohort study. Study researchers provided patients with morphine, oxycodone or a placebo to take orally for the pain as needed over a a period of six months. As instructed, patients recorded their pain levels and daily doses.
Dr. Michael Saenger, assistant professor of Medicine at Emory University School of Medicine, told Clinical Pain Advisor via email that “chronic pain may be [a] ‘disease,’ but [it] can best be understood and treated from psycho-social-spiritual-biomedical framework.”
“The pains that people with ‘high risk’ chronic pain suffer from are real and arising from imbalances in PSSB whole personhood,” he said. “Sadly our society has assumed that non-biomedical pain is not real (while the brain processes all these PSSB pains through similar pathways), so it shouldn’t be surprising that persons hurting psycho-socially express their distress in somatic ways and providers give them opioids.”
There are other options physicians can use when treating chronic lower back pain patients with psychiatric disorders, Saenger said. These alternative include cognitive behavior therapy (CBT) and assertive community treatment (ACT); deep breathing; stress management; yoga or Tai Chi; acupuncture; and spinal manipulation.
He also noted that physicians could do a better job of “listening to them and not abandoning them.”
Around 20% of people who are affected by acute lower back pain eventually develop chronic lower back pain, which is classified as pain lasting for more than three months.2
1. Wasan A, et al, Anesthesiology, 2015, In press.
2. Ninds.nih.gov. Low Back Pain Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS). 2015. Available at: http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm. Accessed July 8, 2015.