Doctors at Saint Louis University say patients who increased doses of opioid medicines to manage chronic pain were more likely to experience an increase in depression.



The study, “Change in opioid dose and change in depression in a longitudinal primary care patient cohort,” appears in the February 2015 edition of the journal PAIN. The study expands the authors’ findings in a previous study of Veterans Administration (VA) patients.

“Better understanding of temporal relationship between opioids and depression and the dose of opioids that places patients at risk for depression may inform prescribing and pain management and improve outcomes for patients with chronic, non-cancer pain,” the study found.

Previous research had found depression to be linked with patients’ opioid use, but this study has identified the association between an increase in opioid use and an increase in depression.1

This is clearly not the first study to site the use of opioid painkillers and depression, whether it is new onset of usegae, prolonged useage, or increased useage of painkillers.

Extended use of painkillers after surgery

On of the greatest abuses of painkillers occurs after surgery. Researchers writing in the medical journal Anesthesia & Analgesia warn against prolonged pain-killer usage after surgery.

The researchers looked at 109 patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. They measured preoperative psychological distress and substance use, and then measured the daily use of opioids until patients reported the cessation of both opioid consumption and pain.

They reported “Preoperative factors, including legitimate prescribed opioid use, self-perceived risk of addiction, and depressive symptoms each independently predicted more prolonged opioid use after surgery. Each of these factors was a better predictor of prolonged opioid use than postoperative pain duration or severity.”2

Too much pain medication

Researchers at Northwestern University said in recently published research that many consumers do not recognize or differentiate the active ingredient inover the counter pain medicines, nor do they necessarily closely adhere to package or label instructions. Given the prevalence of the problem, risk of significant adverse effects, and lack of a learned intermediary i.e. a physician to guide decision making and counsel consumers on proper use, we believe this to be a serious public health threat requiring urgent attention.3

Recently we noted a study published in the Archives of Internal Medicine suggesting that prescribing opioids for pain to older patients within seven days of short-stay surgery appears to be associated with long-term analgesic (pain-killer) use.

Patients are frequently prescribed analgesics after ambulatory or short-stay surgery in anticipation of postoperative pain and the most common analgesics prescribed to outpatients are opioids (such as codeine and oxycodone) and nonsteroidal anti-inflammatory drugs (NSAIDS). While opioids can be beneficial, they are associated with such adverse effects as sedation, constipation and respiratory depression, and their long-term use can lead to physiologic tolerance and addiction, the authors write in their study background.

Doctors note that the prescription of codeine after short-stay surgery may contribute to the use of other potent opioids, such as oxycodone, which have been shown to be associated with increased morbidity and mortality. Further these points do not even consider that the continued use of opioids after one year raises the possibility that the exposure may result in addiction or physical dependence.4

Chronic pain is a condition that affects many people. Many hope to manage that pain with over-the-counter painkillers like Motrin or Tylenol or narcotics like oxycodone. But at the Magaziner Center for Wellness, there are better ways. Ways that are not just pain management techniques, but healing techniques that eliminate the need for pain-killers.

More research
The side-effects of prescription narcotics including dependence or hyperalgesia (an increased sensitivity to pain) should be enough to make anyone concerned of their usage and to seek alternative remedies. One such remedy for knee pain is Total Knee Replacement. Total Knee Replacement has its own complications but now researchers say opioid medication usage makes those complications much more likely.

Recently research showed that people who resort to total knee replacement, who used opioid medications prior to the surgery were at substantially greater risk for complications and painful prolonged recoveries.

In fact of the 49 patients studied who used pain medications prior to knee replacement, five arthroscopic evaluations and eight revision surgeries were needed for persistent stiffness and/or pain, and ten patients were referred for outpatient pain management. These were very significant findings, indeed.5

Here at the Magaziner Center for Wellness, our plan is to seek pain out at its source: the damaged tissue, joints, muscles, nerves, ligaments or tendons. We avoid pain medication usage and we help patients avoid surgery. Even patients who have tried chiropractic, epidural steroids, nerve blocks and even surgery with less than hoped for results, can be cured by Prolotherapy and Platelet-Rich Plasma (PRP) treatments.

Are you living on pain medications, over-the-counter and prescribed and want to explore a different way? Contact us.

1. Saint Louis University Medical Center. “Higher opioid doses associated with increase in depression.” ScienceDaily. ScienceDaily, 13 February 2015. <www.sciencedaily.com/releases/2015/02/150213144220.htm>.

2. Carroll I, Barelka P, Wang CK, et al. A Pilot Cohort Study of the Determinants of Longitudinal Opioid Use After Surgery. Anesth Analg. 2012 Jun 22. [Epub ahead of print]

3. Wolf MS et al (2012). Risk of unintentional overdose with non-prescription acetaminophen products. Journal of General Internal Medicine; DOI: 10.1007/s11606-012-2096-3

4. Alam A, Gomes T, Muhammad M, et al. Long-term Analgesic Use After Low-Risk Surgery,Arch Intern Med. 2012;172(5):425-430.

5. Zywiel MG, Stroh DA, Lee SY, Bonutti PM, Mont MA. Chronic opioid use prior to total knee arthroplasty. J Bone Joint Surg Am. 2011 Nov 2;93(21):1988-93.