PRECISION Participant Pain Scores and Opioid Use According to History of Depression, Demographics, and Antidepressant Use

Purpose American College of Physicians and CDC guidelines for chronic pain advocate for noninvasive techniques and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapies. Duloxetine or tramadol are recommended second line pharmacologic therapies and opioids should be considered only if potential benefits outweigh the risks. We report associations of pain intensity scores, race, depression, and medication usage on predictive values for chronic low back pain (CLBP), using data from 426 patients within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION). Methods CLBP intensity was classified as mild-moderate (0-6) or severe (7-10) based on numerical rating scale (NRS). Logistic regression was used to compute odds ratios and 95% confidence intervals (CIs) for associations between depression and the following predictor variables: demographics, pain intensity, and medications. Means and 95% CIs were computed according to reported use of antidepressants, tramadol, other opioids, NSAIDs, and according to age, race, ethnicity, and gender. Hypotheses were assessed at the .05 level of statistical significance with two-sided testing. Results Patients reporting a history of depression were more likely to use opioids and have higher NRS scores. African-American women who reported a history of depression taking both opioids and antidepressants displayed the highest NRS scores. Conclusions Depression was a statistically significant risk factor for higher NRS scores and opioid use. Additional studies of the effects of depression, use of antidepressants, concomitant use of opioids, NSAIDS, and other medications are warranted to determine optimal therapies for chronic pain sufferers.