Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain

Ajay D. Wasan, Edward Michna, Robert R. Edwards, Jeffrey N. Katz, Srdjan S. Nedeljkovic, Andrew J. Dolman, David Janfaza, Zach Isaac, Robert N. Jamison

Research output: Contribution to journalArticle

Abstract

Background: Opioids are frequently prescribed for chronic low back pain (CLBP), but there are little prospective data on which patient subgroups may benefit. Psychiatric comorbidity, such as high levels of depression and anxiety symptoms (termed comorbid negative affect [NA]), is a common presentation and may predict diminished opioid analgesia and/or increased opioid misuse. Methods: The authors conducted a 6.-month prospective cohort study of oral opioid therapy, with an active drug/placebo run-in period, in 81 CLBP patients with low, moderate, and high levels of NA. Treatment included an opioid titration phase with a prescribing physician blinded to NA group assignment and a 4-month continuation phase, during which subjects recorded daily pain levels using an electronic diary. The primary outcome was the percent improvement in average daily pain, summarized weekly. Results: There was an overall 25% dropout rate. Despite the high NA group being prescribed a higher average daily dose of morphine equivalents, linear mixed model analysis revealed that the 24 study completers in each of the high NA and low NA groups had an average 21 versus 39% improvement in pain, respectively (P 0.01). The high NA group also had a significantly greater rate of opioid misuse (39 vs. 8%, P 0.05) and significantly more and intense opioid side effects (P 0.01). Conclusions: These results indicate that the benefit and risk considerations in CLBP patients with high NA versus low NA are distinctly different. Thus, NA is an important phenotypic variable to characterize at baseline, before deciding whether to prescribe opioids for CLBP.

Original languageEnglish (US)
Pages (from-to)861-872
Number of pages12
JournalAnesthesiology
Volume123
Issue number4
StatePublished - Oct 1 2015
Externally publishedYes

Fingerprint

Low Back Pain
Analgesia
Opioid Analgesics
Psychiatry
Comorbidity
Pain
Morphine
Linear Models
Cohort Studies
Anxiety
Placebos
Prospective Studies
Depression
Physicians
Therapeutics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Wasan, A. D., Michna, E., Edwards, R. R., Katz, J. N., Nedeljkovic, S. S., Dolman, A. J., ... Jamison, R. N. (2015). Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology, 123(4), 861-872.

Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. / Wasan, Ajay D.; Michna, Edward; Edwards, Robert R.; Katz, Jeffrey N.; Nedeljkovic, Srdjan S.; Dolman, Andrew J.; Janfaza, David; Isaac, Zach; Jamison, Robert N.

In: Anesthesiology, Vol. 123, No. 4, 01.10.2015, p. 861-872.

Research output: Contribution to journalArticle

Wasan, AD, Michna, E, Edwards, RR, Katz, JN, Nedeljkovic, SS, Dolman, AJ, Janfaza, D, Isaac, Z & Jamison, RN 2015, 'Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain', Anesthesiology, vol. 123, no. 4, pp. 861-872.
Wasan, Ajay D. ; Michna, Edward ; Edwards, Robert R. ; Katz, Jeffrey N. ; Nedeljkovic, Srdjan S. ; Dolman, Andrew J. ; Janfaza, David ; Isaac, Zach ; Jamison, Robert N. / Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. In: Anesthesiology. 2015 ; Vol. 123, No. 4. pp. 861-872.
@article{9b07bfe7a8f04ec6851428026ec14f90,
title = "Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain",
abstract = "Background: Opioids are frequently prescribed for chronic low back pain (CLBP), but there are little prospective data on which patient subgroups may benefit. Psychiatric comorbidity, such as high levels of depression and anxiety symptoms (termed comorbid negative affect [NA]), is a common presentation and may predict diminished opioid analgesia and/or increased opioid misuse. Methods: The authors conducted a 6.-month prospective cohort study of oral opioid therapy, with an active drug/placebo run-in period, in 81 CLBP patients with low, moderate, and high levels of NA. Treatment included an opioid titration phase with a prescribing physician blinded to NA group assignment and a 4-month continuation phase, during which subjects recorded daily pain levels using an electronic diary. The primary outcome was the percent improvement in average daily pain, summarized weekly. Results: There was an overall 25{\%} dropout rate. Despite the high NA group being prescribed a higher average daily dose of morphine equivalents, linear mixed model analysis revealed that the 24 study completers in each of the high NA and low NA groups had an average 21 versus 39{\%} improvement in pain, respectively (P 0.01). The high NA group also had a significantly greater rate of opioid misuse (39 vs. 8{\%}, P 0.05) and significantly more and intense opioid side effects (P 0.01). Conclusions: These results indicate that the benefit and risk considerations in CLBP patients with high NA versus low NA are distinctly different. Thus, NA is an important phenotypic variable to characterize at baseline, before deciding whether to prescribe opioids for CLBP.",
author = "Wasan, {Ajay D.} and Edward Michna and Edwards, {Robert R.} and Katz, {Jeffrey N.} and Nedeljkovic, {Srdjan S.} and Dolman, {Andrew J.} and David Janfaza and Zach Isaac and Jamison, {Robert N.}",
year = "2015",
month = "10",
day = "1",
language = "English (US)",
volume = "123",
pages = "861--872",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain

AU - Wasan, Ajay D.

AU - Michna, Edward

AU - Edwards, Robert R.

AU - Katz, Jeffrey N.

AU - Nedeljkovic, Srdjan S.

AU - Dolman, Andrew J.

AU - Janfaza, David

AU - Isaac, Zach

AU - Jamison, Robert N.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background: Opioids are frequently prescribed for chronic low back pain (CLBP), but there are little prospective data on which patient subgroups may benefit. Psychiatric comorbidity, such as high levels of depression and anxiety symptoms (termed comorbid negative affect [NA]), is a common presentation and may predict diminished opioid analgesia and/or increased opioid misuse. Methods: The authors conducted a 6.-month prospective cohort study of oral opioid therapy, with an active drug/placebo run-in period, in 81 CLBP patients with low, moderate, and high levels of NA. Treatment included an opioid titration phase with a prescribing physician blinded to NA group assignment and a 4-month continuation phase, during which subjects recorded daily pain levels using an electronic diary. The primary outcome was the percent improvement in average daily pain, summarized weekly. Results: There was an overall 25% dropout rate. Despite the high NA group being prescribed a higher average daily dose of morphine equivalents, linear mixed model analysis revealed that the 24 study completers in each of the high NA and low NA groups had an average 21 versus 39% improvement in pain, respectively (P 0.01). The high NA group also had a significantly greater rate of opioid misuse (39 vs. 8%, P 0.05) and significantly more and intense opioid side effects (P 0.01). Conclusions: These results indicate that the benefit and risk considerations in CLBP patients with high NA versus low NA are distinctly different. Thus, NA is an important phenotypic variable to characterize at baseline, before deciding whether to prescribe opioids for CLBP.

AB - Background: Opioids are frequently prescribed for chronic low back pain (CLBP), but there are little prospective data on which patient subgroups may benefit. Psychiatric comorbidity, such as high levels of depression and anxiety symptoms (termed comorbid negative affect [NA]), is a common presentation and may predict diminished opioid analgesia and/or increased opioid misuse. Methods: The authors conducted a 6.-month prospective cohort study of oral opioid therapy, with an active drug/placebo run-in period, in 81 CLBP patients with low, moderate, and high levels of NA. Treatment included an opioid titration phase with a prescribing physician blinded to NA group assignment and a 4-month continuation phase, during which subjects recorded daily pain levels using an electronic diary. The primary outcome was the percent improvement in average daily pain, summarized weekly. Results: There was an overall 25% dropout rate. Despite the high NA group being prescribed a higher average daily dose of morphine equivalents, linear mixed model analysis revealed that the 24 study completers in each of the high NA and low NA groups had an average 21 versus 39% improvement in pain, respectively (P 0.01). The high NA group also had a significantly greater rate of opioid misuse (39 vs. 8%, P 0.05) and significantly more and intense opioid side effects (P 0.01). Conclusions: These results indicate that the benefit and risk considerations in CLBP patients with high NA versus low NA are distinctly different. Thus, NA is an important phenotypic variable to characterize at baseline, before deciding whether to prescribe opioids for CLBP.

UR - http://www.scopus.com/inward/record.url?scp=84942065472&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942065472&partnerID=8YFLogxK

M3 - Article

C2 - 26375824

AN - SCOPUS:84942065472

VL - 123

SP - 861

EP - 872

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 4

ER -