Depression in opioid-dependent chronic pain patients in rural Texas: a complex relationship

Purpose: Chronic pain and depression are frequently cited as two of the most common causes for seeing a primary care provider. The link between pain, depression, and opioid use has an interdependent relationship that has measurable effects on patient care. Rural patients are often more susceptible to the challenges of managing chronic pain and depression. The goal of this study is to evaluate multiple factors of depression and treatment in chronic pain patients using long term opioids amongst three different rural Texas populations.

Methods: Participants were recruited at local clinics in Graham, Athens, and Andrews, Texas. Patients included in the study were adults aged 18+ who have used opioid pain medication for greater than three months. A survey and Patient Health Questionnaire-9 scoring (PHQ9) questionnaire were self-completed by each participant. The survey gathered information on participant demographics, description of pain and medication use, limited medical history, and alternative pain therapy.

Results: In total, 107 people enrolled in the study. After reviewing data, 27 (25.2%) incomplete surveys were excluded, leaving a total of 80 surveys for analysis. Of the remaining participants, 28 (35%) were from Graham, 48 (60%) from Athens, and 4 (5%) from Andrews. Forty-seven respondents (58.8%) were female and 33 (41.3%) were male. Average age of respondents was 64.74 years (SD=13.05). Depression, as diagnosed by PHQ9, was identified in 45 (56.3%) of participants. Significant risk factors for clinical depression among study participants included family history of substance abuse (OR=23.67, p=0.008), personal history of depression (OR=6.86, p<0.001) and previous session with a counselor or therapist (OR=2.76, p=0.035). The severity of depression in study participants was significantly associated with a prescription for Naloxone (p=0.015), family history of substance abuse (p<0.001), personal history of depression (p<0.001), current use of an SSRI (p<0.001), and the use of physical therapy (p=0.036). Additionally, there was a statistically significant difference in mean pain scale scores (p=0.022), length of opioid use (p=0.011), and PHQ9 scores (p=0.02) between participants from Graham and Athens.

Conclusions: The results of this study suggests a high burden of depression among study participants and enhances our understanding of the risk factors for depression among chronic pain patients in these communities. The data further emphasizes the need for proper depression screening and treatment for individuals with chronic pain and opioid use. Further research should explore effects of rural physician beliefs about prescribing opioids with antidepressants, rural vs urban opioid prescribing practices, and the relationship between opioid use and other common mental health conditions.