Posted by Phillipa on September 28, 2010, at 21:04:22
Interesting seems now there is a study which looked at returning those with chronic back pain back to work and it also improved anxiety depression as it's expected with osteoarthritis or other back conditions. Phillipa
American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting
This coverage is not sanctioned by, nor a part of, the American Academy of Pain Management.
From Medscape Medical News
Opioids Help Stabilize Depression, Anxiety in Patients With Chronic Low Back Pain
Nancy A. MelvilleAuthors and Disclosures
September 28, 2010 (Las Vegas, Nevada) The long-term use of opioid medications for chronic noncancer-related pain, such as osteoarthritis and chronic lower back pain, may help slow or prevent increases in depression, anxiety, or other mental health issues in such patients, according to research presented here at the American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting.In the study, 1302 patients with chronic low back pain and 407 with osteoarthritis completed the Depression, Anxiety, and Positive Outlook Scale (DAPOS) questionnaire to gauge depression, anxiety, and positive outlook at baseline and 6 months and 12 months after opioid therapy. DAPOS contains 11 items that are rated on a 5-point Likert-type scale (with 1 indicating almost never and 5 indicating almost all the time); higher scores indicate greater depression, greater anxiety, and greater positive outlook. Mean (SE) scores were calculated and summarized using frequency distributions.
The results showed stabilized or slightly improved levels of the mental health factors during the observation, reported Errol M. Gould, PhD, director of clinical development and medical affairs at Endo Pharmaceuticals, headquartered in Chadds Ford, Pennsylvania, and lead author of the study.
The patients were part of the Opioid Utilization Study, a 1-year multicenter, prospective, observational cohort study Dr. Gould described as the first of its kind, gathering long-term data on opioid therapy for patients with chronic low back pain.
Patients experiencing chronic pain often have depression, anxiety, or both related to their physical discomfort, and although the study results showed only slight improvements in depression and anxiety, rates may have otherwise been expected to further decline, Dr. Gould noted.
"Patients with chronic pain are commonly depressed or have anxiety, so we wanted to evaluate whether treatment with opioid medications actually helps that," he said.
"The patients entered the study with moderate depression and anxiety, but they remained stable over the course of the 12 months. You might expect them to go downhill if they're not being treated, so at least if they're stable and not getting worse, clinicians can come to some kind of common ground with that patient and work to move forward."
At baseline, 84% of the population had a history of chronic pain for more than 1 year, and 69% had received opioid therapy for more than a year. The mean baseline DAPOS scores among patients with chronic low back pain and osteoarthritis showed mild depression (2.3 and 2.2, respectively), mild anxiety (2.3 and 2.1, respectively), and a moderately positive outlook (3.7 and 3.8, respectively).
At 1 year, the mean scores for patients with chronic low back pain and osteoarthritis indicated no change or slight improvement in depression (2.1 and 2.2, respectively), anxiety (2.0 and 2.0, respectively), and positive outlook (3.7 and 3.8, respectively).
The ongoing study also has the objective of evaluating aspects of the pharmacoeconomic impact of treating patients with opioids, Dr. Gould said.
"One of the other endpoints we are looking at on the pharmacoeconomic side is whether patients are able to work again and become productive with opioid treatment," he said.
"What it's really all about is treating patients so that they can become productive again. Their pain may never go away more than likely you treat them to go on to have mild pain not no pain, but if the pain has been reduced to the point where the patient can go back to work, that's a good thing."
Perry G. Fine, MD, a professor of anesthesiology at the University of Utah School of Medicine in Salt Lake City and president-elect of the AAPM, agreed that even if a drug may not substantially improve depression in a patient with chronic pain, preventing further decline is critical.
"If you see a patient who has had pain for more than 3 to 6 months, it would be foolish not to guess that they likely also have a mood or sleep disturbance," he said. "The disturbance can affect their ability to cope, cause them to become less resilient and socialized and unable to function in the world, and that only makes them even more isolated and demoralized.
"It's a downward negative spiral and if you can unwind that and bring a patient back to a more normal mood state with pain control, that can be a great benefit," Dr. Fine asserted.
The study was supported by Endo Pharmaceuticals Inc. Dr. Gould is director of clinical development and medical affairs at Endo Pharmaceuticals. Dr. Fine's disclosures include that he is on the advisory boards for Alpharma, Forest Laboratories, Ortho McNeil, Purdue Pharma, Endo Pharmaceuticals, Lilly, Cephalon, and King Pharmaceuticals.
American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting: Poster 24. Presented September 23, 2010.
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