Back Pain

23 June 2017

Back pain patients with depression get more opioids

There is strong evidence that depressed patients are at greater risk for misuse and overdose of opioids.


Back pain not only causes physical pain but could also lead to emotional stress because of suffering, dependence on painkillers and difficulty performing everyday tasks.

Patients with low back pain who are depressed are more likely to be prescribed opioids, and to be prescribed higher doses, a new study finds.

A previous Health24 article advised that prescribers should be tentative about what they prescribe and should educate patients that if they are going to prescribe opioids, there is a high chance that the patient may become dependent.

The current study was published in the journal PAIN Reports.

Low back pain is a leading cause of disability in the United States and the most common reason for opioid prescriptions, the researchers said.

Statistics about the situation in South Africa are not available.

Opioid overuse

"There is strong evidence that depressed patients are at greater risk for misuse and overdose of opioids," said study senior author Dr John Markman. He directs the University of Rochester Medical Center's Translational Pain Research Program, in New York.

The unwelcome presence of back pain can also lead to increased risk of suicide Health24 previously reported.

The analysis of nationwide US data on nearly 5 400 people from 2004 to 2009 found that patients with back pain who screened positive for depression were more than twice as likely to be prescribed an opioid painkiller. Over a year's time, they also got more than twice the typical dose, the study found.

Avoid the risk of painkillers

The researchers said learning more about these patterns can improve understanding of the US opioid epidemic. It will also help evaluate the success of efforts to control prescription opioid abuse, they said.

Markman said more research is needed to understand the risks and benefits of prescribing painkilling drugs to patients with low back pain and depression.

He noted that low back pain is the condition most often studied to approve new pain medications.

This may lead clinicians – who rely on these studies – to underestimate the risk opioids pose when they are prescribed for low back pain in routine practice, Markman said in a Rochester news release.

This excludes depressed patients in a routine back pain check-up and practice.

Read more:

Drug-free treatment for lower back pain best option

Understanding chronic pain

Opioid dependence – is something we should know about


Ask the Expert

Backache expert

Susan qualified as a Physiotherapist in 1990, and completed her master’s degree in Physiotherapy in 2013 at the University of Pretoria. She has a special interest in human biomechanics, as well as the interaction between domestic and work-related ergonomics.

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