Depression and back pain lessens pain relief from narcotic painkillers
A new study revealed that narcotic painkillers may not be the best therapy for patients with chronic back pain who has also experienced depression or anxiety.
"A lot of patients have depression and anxiety on top of their back pain," said lead researcher Dr. Ajay Wasan, a professor of anesthesiology and psychiatry at the University Of Pittsburgh School Of Medicine. Pain can make depression and anxiety worse and depression and anxiety can make pain worse, Wasan said. "It's a two-way street."
Narcotic painkillers might provide less pain relief in people with depression or anxiety and have a higher rate of misuse of their medications. Misuse includes taking too many pills and running out of medication early, doctor getting prescriptions for the same drug from several doctors and using marijuana or cocaine along with narcotic painkillers. Doctors should know whether someone has depression or anxiety before prescribing a narcotic painkiller. "That needs to be assessed and needs to be treated which improves pain by itself," he added.
The study was published in Journal of Anesthesiology and included 55 people with chronic lower back pain and low to high levels of depression or anxiety. Patients were randomly given morphine, oxycodone, or a placebo for six months. About 21% pain improvement was found in patients with high levels of depression and anxiety along with painkiller abuse and 39% with low level of depression and anxiety. The study found more side effects from narcotic medications such as constipation, nausea, fatigue and confusion, The American Academy of Family Physicians, reported.
Dr. Allyson Shrikhande, a physiatrist at Lenox Hill Hospital in New York City, said, "Using narcotics to treat chronic back pain in patients with a history of a psychiatric disorder may not be effective in decreasing the pain." In addition, patients with history of anxiety or depression can have an increased risk of addiction to pain medication versus a person without a psychiatric history.
Shrikhande said, "This is due to the effect of narcotic medications on the neurohormonal balance. It is important for physicians treating back pain to inquire about a patient's psychiatric history prior to initiating treatment. A team approach is also vital, using experts such as psychiatrists and psychologists to assist in managing the patient". Dr. Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y. said, "Narcotic painkillers are a temporary 'band-aid' and often exacerbate the problem."
As the rates of narcotic addiction are increasing so, the doctors should be prepared for other treatments available to patients for chronic back pain. Some conditions such as depression and anxiety should be self treated, which in turn will provide more effective pain relief, he added.
"This study reinforces the importance of screening for coexisting conditions and treating them effectively," Krakower said. "If the anxiety and mood symptoms diminish, then there is a better chance of relieving pain in the long run”.