title: Combined Use of Opioids and Antidepressants in the Treatment of Pain: A Review of Veterans Health Administration Data for Patients with Pain Both With and Without Co-morbid Depression.
abstract: Musculoskeletal pain is prevalent among Veterans treated within the Veterans Health Administration (VHA). Depression is highly co-prevalent, and antidepressants are increasingly being used for psychiatric and analgesic benefit. The current study examined prescribing patterns of antidepressants and opioids in the context of musculoskeletal pain using a national VHA database. All Veterans diagnosed with musculoskeletal pain who attended at least one appointment through the VHA during Fiscal Year 2012 were dichotomized based on the presence or absence of a depression diagnosis. We compared the proportion in each group that were prescribed antidepressants to the entire sample and repeated this comparison along a continuum of the number of annual opioid prescriptions received (ranging in five categories from no opioids up to >20 scripts). Of the 5.1 million Veterans seen, 19.1 % were diagnosed with musculoskeletal pain, of whom, 27.2 % were diagnosed with major depressive disorder. Antidepressants were prescribed to 78.41 % of patients with musculoskeletal pain and depression, compared to 20.23 % of those without depression. For both groups, antidepressant use increased linearly as annual opioid fills increased. Across the categories of opioid use, patients with depression showed a 13.98 % increase in antidepressant use, compared to a 33.97 % increase in the non-depressed group. Results suggest that antidepressants are frequently prescribed to patients with musculoskeletal pain who are using opioids, consistent with multi-modal pharmacotherapy. Increasing use of antidepressants in conjunction with escalating opioid prescribing, particularly in the absence of diagnosed depression, suggests that antidepressants are being used in both groups to complement opioid therapy.
authors.affiliation: VA Connecticut Healthcare System, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT, 06516, USA. john.sellinger1@va.gov.|Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. john.sellinger1@va.gov.
authors.forename: John J
authors.initials: JJ
authors.lastname: Sellinger
authors.affiliation: VA Connecticut Healthcare System, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT, 06516, USA.|Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.|VA New England Mental Illness, Research, Education and Clinical Center, West Haven, CT, USA.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sofuoglu
authors.affiliation: VA Connecticut Healthcare System, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT, 06516, USA.|Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.affiliation: VA Connecticut Healthcare System, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT, 06516, USA.|Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.|VA New England Mental Illness, Research, Education and Clinical Center, West Haven, CT, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D059350:Chronic Pain / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D059352:Musculoskeletal Pain / Q000188:drug therapy*; D059408:Pain Management; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents
keywords: Antidepressants; Depression; Opioids; Pain management