Thursday, October 7, 2010

Opioids as Mentally Beneficial? Worth Pondering.

Briefly NotedAccording to new research, the long-term use of opioid analgesics for chronic noncancer-related pain may also help slow or prevent increases in depression or anxiety while maintaining a positive outlook. This and other evidence suggests that opioids might confer mental health benefits in addition to their pain-relieving qualities.

At the recent American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting, Steven P. Stanos, DO, and colleagues present a study of 1,302 patients with chronic low back pain and 407 with osteoarthritis [Melville 2010]. Each participant completed the Depression, Anxiety, and Positive Outlook Scale (DAPOS) questionnaire to gauge those factors at baseline and at 6 and 12 months on opioid-analgesic therapy. At baseline, 84% had a history of chronic pain of >1 year and more than two thirds (69%) had received opioid therapy for more than a year. Most patients entered the study with moderate depression and anxiety but results showed stabilized or slightly improved levels of those mental health factors, including positive outlook, during the period of observation.

COMMENT: Patients experiencing chronic pain often have depression, anxiety, or both related to their physical discomfort and, without effective treatment, those mental conditions might be expected to worsen. In this industry-supported study (Endo Pharmaceuticals) subjects showed only modest improvements in depression and anxiety; however, they were at least stable and not getting worse, which could allow them to benefit further from pain management strategies, and becoming better psychologically adjusted and more physically productive.

There is still the question of whether opioids themselves benefit mental health or the primary effect on depression, anxiety, and positive outlook is the comforting relief of pain afforded by opioids. A recent and thought-provoking article by Thomas H. Sachy, MD, MSc in Practical Pain Management, also released at the AAPM meeting, suggests that opioids are inherently beneficial for a range of psychiatric disorders and this has been essentially known for centuries [Sachy 2010]. By helping to regulate and augment the endogenous opioid system, largely in limbic brain structures, opioid analgesics appear to play an important role in favorably modulating mood, temperament, and personality — above and beyond any reduction of pain symptoms. Conversely, untreated or undertreated pain (eg, inadequate opioid therapy), may result in a patient who is anxious, dysphoric, irritable, and restless. An appreciation of the potential psychotropic properties of opioids, aside from their analgesic effects, could be important for treating both the physical and mental dimensions of pain.

REFERENCES:
> Melville NA. Opioids Help Stabilize Depression, Anxiety in Patients With Chronic Low Back Pain. Medscape Medical News. 2010(Sep 28) [
article here]. Reporting on: Stanos SP, et al. Psychometric measures with opioids in chronic noncancer pain. AAPM 21st Annual Clinical Meeting: Poster 24, presented September 23, 2010.
> Sachy TH. Use of opioids in pain patients with psychiatric disorders. Practical Pain Management. 2010(Sep);10(7):17-18+. Access PPM [
here] and healthcare providers may register for a free subscription [here].