Does Depression Increase Opioid Use Among OA Patients?

To examine the role of mental health and social support in the use of different pain medications among knee osteoarthritis (OA) patients, a team of researchers examined 360 individuals, categorizing them based on use of these oral medications: opioids (with/without other oral analgesic treatments), non-opioid analgesics, and no oral analgesic treatment.

The study, “Social & psychological factors associated with oral analgesic use in knee osteoarthritis management,” was published in the February 1, 2019 edition of Osteoarthritis and Cartilage.

Co-author Ernest R. Vina, M.D., M.S., assistant professor of medicine in the University of Arizona College of Medicine, explained the foundation for the study to OTW, “In the ambulatory setting, we have found that patients’ social and psychological health tend to affect whether or not they will use certain medications. For example, those with low level of social support tend to rely more on prescription than over-the-counter pain medications. Those with mental health challenges, such as depression or anxiety, are also more likely to use opioid medicines.”

“The majority of patients with knee OA in the study were not using opioid medications. Most were using acetaminophen and/or anti-inflammatory agents. Opioid analgesic users, compared to others, were more likely to have moderate-to-severe depressive symptoms and lower social support. A higher level of depression was also associated with opioid vs. no oral analgesic use, independent of various patient sociodemographic and clinical (like OA disease severity and body mass index) characteristics.”

Specifically, of the patients who were enrolled in the study, 30.6% (n = 110) reported taking opioid analgesics for OA, 54.2% (n = 195) reported non-opioid use, and 15.3% (n = 55) reported no oral analgesic use. The investigators also recorded that patients who self-reported opioid use also reported lower mean social support scores and were more likely to have moderate-severe depressive symptoms.

Dr. Vina, also with the University of Arizona Arthritis Center, summarized the conclusions from the study to OTW, “Physicians and surgeons should consider screening OA patients for mood disorders, such as depression. Identification of such psychological disorders could lead to an early implementation of a management plan to improve the outcomes of patients with OA. Prescribing an anti-depressant therapy or referring a patient to a mental health specialist in tandem with providing a medication for OA may be appropriate in certain patients.”

“There is a growing opioid epidemic in the U.S. Knee OA patients with severe depression symptoms and those with low level of social support are more likely to report using opioid analgesics for OA treatment.”