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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Phillipa on September 28, 2010, at 21:04:22
Interesting seems now there is a study which looked at returning those with chronic back pain back to work and it also improved anxiety depression as it's expected with osteoarthritis or other back conditions. Phillipa
American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting
This coverage is not sanctioned by, nor a part of, the American Academy of Pain Management.
From Medscape Medical News
Opioids Help Stabilize Depression, Anxiety in Patients With Chronic Low Back Pain
Nancy A. MelvilleAuthors and Disclosures
September 28, 2010 (Las Vegas, Nevada) The long-term use of opioid medications for chronic noncancer-related pain, such as osteoarthritis and chronic lower back pain, may help slow or prevent increases in depression, anxiety, or other mental health issues in such patients, according to research presented here at the American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting.In the study, 1302 patients with chronic low back pain and 407 with osteoarthritis completed the Depression, Anxiety, and Positive Outlook Scale (DAPOS) questionnaire to gauge depression, anxiety, and positive outlook at baseline and 6 months and 12 months after opioid therapy. DAPOS contains 11 items that are rated on a 5-point Likert-type scale (with 1 indicating almost never and 5 indicating almost all the time); higher scores indicate greater depression, greater anxiety, and greater positive outlook. Mean (SE) scores were calculated and summarized using frequency distributions.
The results showed stabilized or slightly improved levels of the mental health factors during the observation, reported Errol M. Gould, PhD, director of clinical development and medical affairs at Endo Pharmaceuticals, headquartered in Chadds Ford, Pennsylvania, and lead author of the study.
The patients were part of the Opioid Utilization Study, a 1-year multicenter, prospective, observational cohort study Dr. Gould described as the first of its kind, gathering long-term data on opioid therapy for patients with chronic low back pain.
Patients experiencing chronic pain often have depression, anxiety, or both related to their physical discomfort, and although the study results showed only slight improvements in depression and anxiety, rates may have otherwise been expected to further decline, Dr. Gould noted.
"Patients with chronic pain are commonly depressed or have anxiety, so we wanted to evaluate whether treatment with opioid medications actually helps that," he said.
"The patients entered the study with moderate depression and anxiety, but they remained stable over the course of the 12 months. You might expect them to go downhill if they're not being treated, so at least if they're stable and not getting worse, clinicians can come to some kind of common ground with that patient and work to move forward."
At baseline, 84% of the population had a history of chronic pain for more than 1 year, and 69% had received opioid therapy for more than a year. The mean baseline DAPOS scores among patients with chronic low back pain and osteoarthritis showed mild depression (2.3 and 2.2, respectively), mild anxiety (2.3 and 2.1, respectively), and a moderately positive outlook (3.7 and 3.8, respectively).
At 1 year, the mean scores for patients with chronic low back pain and osteoarthritis indicated no change or slight improvement in depression (2.1 and 2.2, respectively), anxiety (2.0 and 2.0, respectively), and positive outlook (3.7 and 3.8, respectively).
The ongoing study also has the objective of evaluating aspects of the pharmacoeconomic impact of treating patients with opioids, Dr. Gould said.
"One of the other endpoints we are looking at on the pharmacoeconomic side is whether patients are able to work again and become productive with opioid treatment," he said.
"What it's really all about is treating patients so that they can become productive again. Their pain may never go away more than likely you treat them to go on to have mild pain not no pain, but if the pain has been reduced to the point where the patient can go back to work, that's a good thing."
Perry G. Fine, MD, a professor of anesthesiology at the University of Utah School of Medicine in Salt Lake City and president-elect of the AAPM, agreed that even if a drug may not substantially improve depression in a patient with chronic pain, preventing further decline is critical.
"If you see a patient who has had pain for more than 3 to 6 months, it would be foolish not to guess that they likely also have a mood or sleep disturbance," he said. "The disturbance can affect their ability to cope, cause them to become less resilient and socialized and unable to function in the world, and that only makes them even more isolated and demoralized.
"It's a downward negative spiral and if you can unwind that and bring a patient back to a more normal mood state with pain control, that can be a great benefit," Dr. Fine asserted.
The study was supported by Endo Pharmaceuticals Inc. Dr. Gould is director of clinical development and medical affairs at Endo Pharmaceuticals. Dr. Fine's disclosures include that he is on the advisory boards for Alpharma, Forest Laboratories, Ortho McNeil, Purdue Pharma, Endo Pharmaceuticals, Lilly, Cephalon, and King Pharmaceuticals.
American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting: Poster 24. Presented September 23, 2010.
Posted by floatingbridge on September 29, 2010, at 12:00:02
In reply to Opiods Help Depression/Anxiety Chronic Back Pain, posted by Phillipa on September 28, 2010, at 21:04:22
Absolutely! I ain't cured, but tramadol has spoon improved my mood AND cut my pain. This article should be shown to any doc who is reticent to give mild opoids. I could go on and on.
(Vicodin did not help my mood in the long run.)
Is opoid synthetic? I forget.... Tramadol is synthetic.
Posted by bulldog2 on September 29, 2010, at 15:03:48
In reply to Opiods Help Depression/Anxiety Chronic Back Pain, posted by Phillipa on September 28, 2010, at 21:04:22
> Interesting seems now there is a study which looked at returning those with chronic back pain back to work and it also improved anxiety depression as it's expected with osteoarthritis or other back conditions. Phillipa
>
> American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting
>
> This coverage is not sanctioned by, nor a part of, the American Academy of Pain Management.
>
> From Medscape Medical News
> Opioids Help Stabilize Depression, Anxiety in Patients With Chronic Low Back Pain
> Nancy A. Melville
>
> Authors and Disclosures
> September 28, 2010 (Las Vegas, Nevada) The long-term use of opioid medications for chronic noncancer-related pain, such as osteoarthritis and chronic lower back pain, may help slow or prevent increases in depression, anxiety, or other mental health issues in such patients, according to research presented here at the American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting.
>
> In the study, 1302 patients with chronic low back pain and 407 with osteoarthritis completed the Depression, Anxiety, and Positive Outlook Scale (DAPOS) questionnaire to gauge depression, anxiety, and positive outlook at baseline and 6 months and 12 months after opioid therapy. DAPOS contains 11 items that are rated on a 5-point Likert-type scale (with 1 indicating almost never and 5 indicating almost all the time); higher scores indicate greater depression, greater anxiety, and greater positive outlook. Mean (SE) scores were calculated and summarized using frequency distributions.
>
> The results showed stabilized or slightly improved levels of the mental health factors during the observation, reported Errol M. Gould, PhD, director of clinical development and medical affairs at Endo Pharmaceuticals, headquartered in Chadds Ford, Pennsylvania, and lead author of the study.
>
> The patients were part of the Opioid Utilization Study, a 1-year multicenter, prospective, observational cohort study Dr. Gould described as the first of its kind, gathering long-term data on opioid therapy for patients with chronic low back pain.
>
> Patients experiencing chronic pain often have depression, anxiety, or both related to their physical discomfort, and although the study results showed only slight improvements in depression and anxiety, rates may have otherwise been expected to further decline, Dr. Gould noted.
>
> "Patients with chronic pain are commonly depressed or have anxiety, so we wanted to evaluate whether treatment with opioid medications actually helps that," he said.
>
> "The patients entered the study with moderate depression and anxiety, but they remained stable over the course of the 12 months. You might expect them to go downhill if they're not being treated, so at least if they're stable and not getting worse, clinicians can come to some kind of common ground with that patient and work to move forward."
>
> At baseline, 84% of the population had a history of chronic pain for more than 1 year, and 69% had received opioid therapy for more than a year. The mean baseline DAPOS scores among patients with chronic low back pain and osteoarthritis showed mild depression (2.3 and 2.2, respectively), mild anxiety (2.3 and 2.1, respectively), and a moderately positive outlook (3.7 and 3.8, respectively).
>
> At 1 year, the mean scores for patients with chronic low back pain and osteoarthritis indicated no change or slight improvement in depression (2.1 and 2.2, respectively), anxiety (2.0 and 2.0, respectively), and positive outlook (3.7 and 3.8, respectively).
>
> The ongoing study also has the objective of evaluating aspects of the pharmacoeconomic impact of treating patients with opioids, Dr. Gould said.
>
> "One of the other endpoints we are looking at on the pharmacoeconomic side is whether patients are able to work again and become productive with opioid treatment," he said.
>
> "What it's really all about is treating patients so that they can become productive again. Their pain may never go away more than likely you treat them to go on to have mild pain not no pain, but if the pain has been reduced to the point where the patient can go back to work, that's a good thing."
>
> Perry G. Fine, MD, a professor of anesthesiology at the University of Utah School of Medicine in Salt Lake City and president-elect of the AAPM, agreed that even if a drug may not substantially improve depression in a patient with chronic pain, preventing further decline is critical.
>
> "If you see a patient who has had pain for more than 3 to 6 months, it would be foolish not to guess that they likely also have a mood or sleep disturbance," he said. "The disturbance can affect their ability to cope, cause them to become less resilient and socialized and unable to function in the world, and that only makes them even more isolated and demoralized.
>
> "It's a downward negative spiral and if you can unwind that and bring a patient back to a more normal mood state with pain control, that can be a great benefit," Dr. Fine asserted.
>
> The study was supported by Endo Pharmaceuticals Inc. Dr. Gould is director of clinical development and medical affairs at Endo Pharmaceuticals. Dr. Fine's disclosures include that he is on the advisory boards for Alpharma, Forest Laboratories, Ortho McNeil, Purdue Pharma, Endo Pharmaceuticals, Lilly, Cephalon, and King Pharmaceuticals.
>
> American Academy of Pain Management (AAPM) 21st Annual Clinical Meeting: Poster 24. Presented September 23, 2010.
>I have severe osteoarthritis of the right hip and sciatica from lumbar stenosis which causes severe pain. When I do yard work or I am active the pain level shoots up. The combination of pain and being confined to my rocker really depresses me. I had been weaning off percocet to be a hero I guess. I went back to my full dose and I felt better both phsyically and mentally.
Sometimes all this anti drug hysteria makes you think you have to get off your meds. Sometimes that's a bad choice.
Percocet + wellbutrin xl + neurontin Equals a smile today.
Posted by Phillipa on September 29, 2010, at 19:58:07
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain, posted by bulldog2 on September 29, 2010, at 15:03:48
And that is good. Phillipa
Posted by floatingbridge on September 29, 2010, at 20:06:58
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain, posted by bulldog2 on September 29, 2010, at 15:03:48
Nice to see you still smiling :)
Posted by floatingbridge on September 29, 2010, at 20:08:00
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain, posted by bulldog2 on September 29, 2010, at 15:03:48
Nice to see you still smiling :)
Posted by bulldog2 on October 1, 2010, at 16:42:04
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain » bulldog2, posted by floatingbridge on September 29, 2010, at 20:08:00
> Nice to see you still smiling :)
Hi getting by most days. Still a struggle to find a good med cocktail. Trying to get by on the least amount of meds.
How are you doing? Are you on anything?
Posted by floatingbridge on October 1, 2010, at 17:27:48
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain, posted by bulldog2 on October 1, 2010, at 16:42:04
Oh yeah. Finally got ultracet and ultram prescriptions, and they work as well as I thought-- much better than norco which turned into a depressant and an escalating dosage. Finally fully clear of it except for occasional emergency usage.
Mood is good, anxiety less, but oddly the depression has become very physiological. Extreme fatigue and generalized pain episodes. Pain Disorder NOS, I suppose.
The rest is same old same old: pristiq, dex, small xanax er.
Read a link from Harvard School of Medicine by Googling 'can chronic depression cause chronic pain'.
Neurontin may be on the horizon.
My pdoc is a blessing. He really gets this
more than I do. I think he actually researches a bit in his non-office hours. That certainly gives me a good feeling.Last session he said meds only last so long and symptoms inevitably break through. You're so on target with adjusting your cocktails. I suppose you'd have chosen a different hobby, but at least you know how to care for yourself.
Oh, seems I've had a rather sudden onset of osteoarthritis. Great. See a rhuemy in two weeks.
Thanks for asking :)
Posted by Phillipa on October 1, 2010, at 20:01:33
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain » bulldog2, posted by floatingbridge on October 1, 2010, at 17:27:48
FB no conversion disorder right? Phillipa
Posted by floatingbridge on October 1, 2010, at 21:04:40
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain » floatingbridge, posted by Phillipa on October 1, 2010, at 20:01:33
> FB no conversion disorder right? Phillipa
What's a conversion disorder? I guess no.
Posted by bulldog2 on October 2, 2010, at 7:56:31
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain » bulldog2, posted by floatingbridge on October 1, 2010, at 17:27:48
> Oh yeah. Finally got ultracet and ultram prescriptions, and they work as well as I thought-- much better than norco which turned into a depressant and an escalating dosage. Finally fully clear of it except for occasional emergency usage.
>
> Mood is good, anxiety less, but oddly the depression has become very physiological. Extreme fatigue and generalized pain episodes. Pain Disorder NOS, I suppose.
>
> The rest is same old same old: pristiq, dex, small xanax er.
>
> Read a link from Harvard School of Medicine by Googling 'can chronic depression cause chronic pain'.
>
> Neurontin may be on the horizon.
>
> My pdoc is a blessing. He really gets this
> more than I do. I think he actually researches a bit in his non-office hours. That certainly gives me a good feeling.
>
> Last session he said meds only last so long and symptoms inevitably break through. You're so on target with adjusting your cocktails. I suppose you'd have chosen a different hobby, but at least you know how to care for yourself.
>
> Oh, seems I've had a rather sudden onset of osteoarthritis. Great. See a rhuemy in two weeks.
>
> Thanks for asking :)
>I'm constantly rotating my med combos. Just seems like I become tolerant to meds and they Poop out. If I rotate every couple months I seems to do better.
Current combo Percocet for osteoarthritis and high dose neurontin. These meds address anxiety and depression for me.
Posted by weatherfreak on October 5, 2010, at 23:41:25
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain, posted by bulldog2 on October 2, 2010, at 7:56:31
I'm taking oxycodone 5mg IR and clonazepam for my chronic back pain. Opiates really help me with depression but I was put on Zyban about 5 weeks ago to try and push it along. All it's done has given me shocking tension and in my opinion made things worse, pain wise. I do prefer stimulating meds, ritalin was great and never did this to me until it pooped out, same with modafinil.
I'd like to ask Bulldog how is neurontin? I've been thinking about it as I stopped my Zyban today. The headache still hasn't gone away yet. I think the muscle tension from it has done some serious damage.
Posted by Phillipa on October 5, 2010, at 23:47:35
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain » bulldog2, posted by weatherfreak on October 5, 2010, at 23:41:25
You can babblemail him and maybe exchange e-mail adresses. Give him yours and he can write you. He can't send babblemails to anyone but you can send to him. Phillipa
Posted by floatingbridge on October 5, 2010, at 23:59:20
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain » bulldog2, posted by weatherfreak on October 5, 2010, at 23:41:25
You can also search his name--he's written about it quite a bit.
Zyban. Is that Wellbutrin? Is so, very different stimulation than ritalin. I don't do well on it either.
A fairly benign muscle relaxant is zanaflex (available in generic). Helps me occasionally.
Posted by weatherfreak on October 7, 2010, at 5:28:19
In reply to Re: Opiods Help Depression/Anxiety Chronic Back Pain » weatherfreak, posted by floatingbridge on October 5, 2010, at 23:59:20
and yes, Zyban is Wellbutrin.
This is the end of the thread.
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