Characteristics of depression in the chronic pain sample include a larger number of medication side effects, greater pain severity and interference, and more opioid medication-related issues.1 Respondents also reported current mental health and substance use problems.

The study’s authors learned that factors associated with developing depression after the onset of pain included poorer physical functions, lower social support and being younger at the onset of pain.

The authors cited a number of reasons why depression could develop after a patient begins opioid treatment for pain: opioids increase pleasure thresholds; prescription painkillers may induce depression symptoms; and the possibility of substance-induced depressive disorder.

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Study author Richard Mattick, PhD, told Clinical Pain Advisor in an interview that there are a few reasons why clinicians lean toward prescribing opioid treatments first before considering alternatives. 

“The pharmaceutical industry promotion, and the lack of easy and affordable alternatives such as non-drug pain management, combined with patient expectation of medical practitioner intervention all promote opioid use, despite the fact that the evidence only supports short-term use of opioids for non-cancer chronic pain,” he said.

Alternatives to ingesting opioids for pain management include acupuncture, yoga, chiropractic, psychotherapy and physical therapy.