title: Symptoms of Depression Are Associated With Opioid Use Regardless of Pain Severity and Physical Functioning Among Treatment-Seeking Patients With Chronic Pain.
abstract: Depression may be a critical factor in the initiation and maintenance of opioids. This study investigated the association among opioid use, pain, and depression in patients evaluated at a university-based outpatient pain clinic. Of the 2,104 new patients included, 55.89% reported current opioid use and showed a worse phenotypic profile (eg, higher pain severity, worse physical functioning) compared with nonopioid users. In addition, more opioid users reported symptoms suggestive of depression than those not taking opioids (43.6% vs 26.8%, P < .001). In a multivariate logistic regression model, increased pain severity was associated with increased probability of taking opioids; however, this was moderated by depression (estimate = -.212, P < .001). For nondepressed patients, the predicted probabilities of opioid use increased as pain severity increased. In contrast, among patients with symptoms of depression, the probability of taking opioids did not change based on pain severity. Similarly, although increased physical function was associated with increased probability of opioid use, this was moderated by depression (estimate = .033, P = .034). Patients with symptoms of depression were more likely to be taking opioids at higher levels of functioning (Ps < .03). Perspective: This study investigated the association among opioid use, pain, and depression at a university-based outpatient pain clinic. Depression emerged as a moderator of the relationship among opioid use, pain severity, and physical functioning. These findings lend support to the hypothesis that patients may be self-medicating affective pain with opioids.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan. Electronic address: jennagoe@med.umich.edu.
authors.forename: Jenna
authors.initials: J
authors.lastname: Goesling
authors.affiliation: College of Literature, Science and Arts, University of Michigan, Ann Arbor, Michigan.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Henry
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Moser
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Mohit
authors.initials: M
authors.lastname: Rastogi
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Afton L
authors.initials: AL
authors.lastname: Hassett
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Brummett
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy* / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D010147:Pain Measurement; D010641:Phenotype; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid
keywords: Opioid therapy; chronic pain; depression; pain interference; pain severity