OTC, prescription pain medications: pain plus depression may lead to medicine overuse

OB/GYN News, June 1, 2004 by Steve Perlstein

ORLANDO, FLA. -- Patients with comorbid pain and depression are significantly more likely to use over-the-counter and prescription pain medication than those with pain only. Bruce A. Arnow, Ph.D., said in a poster presentation at the annual meeting of the American Academy of Pain Medicine.

Those with comorbid pain and depression are also significantly more likely to take more pain medication than they have been prescribed, according to a survey of 5,808 HMO members, reported Dr. Arnow of Stanford (Calif.) University Medical Center.

Based on the results of the survey, Dr. Arnow and his colleagues concluded that physicians should screen their patients for depression before prescribing pain medication, and should alter their medication recommendations accordingly.

Investigators divided the respondents into four groups: chronic pain (pain for at least 6 months) and no depression, chronic pain plus depression, depression only, and neither pain nor depression.

Depressed patients with pain were significantly more likely to report using both over-the-counter and prescription pain medication than were those in the pain-only group, Dr. Arnow reported. They were also significantly more likely than the pain-only group to take more pain medication than prescribed.

Those with depression plus pain reported significantly more pain-related disability and scored significantly higher on the catastrophizing subscale of the Coping Strategies Questionnaire than did the pain-only group.

Of the 5,808 respondents--who were surveyed within 1 week of a primary care visit-45% reported chronic pain and 8% had major depressive disorder (MDD). Of those with chronic pain, 11% had MDD.

Of the 8% of the total population who had depression, 67% reported chronic pain and 55% were "bothered a lot by three or more physical symptoms. Among all respondents, 15% were "bothered a lot" by three or more physical symptoms.

Patients who responded to the survey and met eligibility criteria (48% of the 12,000 contacted) were compared based on various instruments to evaluate MDD, as well as on the Patient Health Questionnaire to assess physical symptoms, the Graded Chronic Pain Scale to assess disability, the Coping Strategies Questionnaire, and questions to evaluate the use of over-the-counter and prescription medications.

BY STEVE PERLSTEIN

Midwest Bureau