Transcript Slide 1

Mental Health Predictors of Pain and Function
in Patients with Chronic Low Back Pain
®
Olivia D. Lara, K. Ashok Kumar MD FRCS Sandra Burge, PhD
The University of Texas Health Science Center at San Antonio
Introduction
Results
Chronic low back pain is one of the most frequent
reasons for visits to a physician. Between 1992 and
2006 the prevalence of chronic low back pain has
risen from 3.9% to 10.2%. While the proportion of
individuals who sought care at a health care provider
increased to 84% in 2009 (1). Individuals with
chronic low back pain place a large, costly demand
on the health care system, and also account for major
disability and absence from work (2).
Past researchers have shown significant correlations
between chronic back pain and mental health factors
such as depression and anxiety (3). However few
studies have investigated the impact that such mental
health factors have on other aspects of health in
chronic pain patients, such as physical functioning,
role functioning, and general health.
This study will evaluate the relationship between
self-reported depression and anxiety, opioid use, pain
severity, physical functioning while controlling for
the causes of back pain.
Materials and Methods
The sample included 367 patients with an average
age of 53 years. Participants were 71.9 % female,
and 27.5 % were male. The most common causes
of low back pain were degenerative disk (35.1%)
and mechanical back pain (12.3%), with 28.9%
having no diagnosis on record.
Of the total participants 56.4% reported feeling
depressed, 32.3% reported feeling generalized
anxiety and 39.8% reported panic attacks in the
previous two weeks.
Based on chi-squared analysis, depression, anxiety
and panic attacks were strongly associated with
opioid use (Figure 1). Furthermore, mental illness
symptoms were associated with physical function,
role function, and general health score (p<.074,
Figure 2).
The specific cause of the back pain had little to do
with pain or functioning outcomes. We discovered
that having versus not having a diagnosis on record
distinguished patients; those with a diagnosis had
significantly worse pain, physical function, and
role function (p<.05)
Mean Scores
Subjects. Student research assistants enrolled 367 adult
patients from 9 outpatient clinics across Texas. Patients
Linear regression analyses examined mental health
were eligible if they had low back pain for 3 months or
and pain diagnosis as predictors of pain, physical
longer, and were excluded if they were pregnant or had
function, role function, and health score. In each
a diagnosis of cancer.
model, mental health issues contributed
significantly to pain and function outcomes. Table
Procedure and Measurement. Students gathered data
1 illustrates the model addressing role function and
from patient surveys and medical records. A 6-page
its association with depression, anxiety and
patient survey addressed demographic characteristics,
diagnosis. This model shows only one outcome,
pain duration, frequency and severity, physical
role function, there are three other models.
functioning and general health, anxiety, depression,
substance abuse, and risk for opioid misuse. Patients
reported pain severity using a 10-point scale. To
Figure 2. Association between Depression and
assess depression and anxiety, investigators used 4 brief
Anxiety and Functional Outcomes
screening questions from PRIME-MD. Two items
3.5
Physical Function
addressed depression (loss of interest and
Physical Role
feeling down), one addressed general anxiety, and one
Health Score
3
addressed panic within the past 2 weeks. From
participants’ medical records, students gathered
2.5
information about causes of low back pain, treatments
for pain (including medications, procedures, and
2
surgeries), comorbidities, and Body Mass Index
(BMI).
Figure 1. Association between Depression
and Anxiety and Opioid Use
160
No Opioid use
Opioid use
140
1
0.5
0
120
Number of Subjects
1.5
Dep -
100
Dep +
Anx -
Anx +
High score is indicator of good function,
good health; low score is very limited
function, poor health.
80
60
40
Conclusions
20
0
Dep -
Dep +
Anx -
Anx +
Depression X2=20.886, p=.000;
Anxiety X2=6.674, p=.010
•Depression, anxiety and panic attacks were very
strong predictors of opioid use in patients. These
results are consistent with past studies which found
that patients with depression report higher pain and
take more opioids (4).
•Patients who reported mental health symptoms also
had worse pain, physical function, role functioning
and health scores.
Table 1. Linear Regression
Outcome= Role Function
Predictors
Beta
p-value
Depression
-.186
.002
Anxiety
-.112
.064
Diagnosis
-.154
.003
Predictors also entered included panic attacks.
Acknowledgements
This study was conducted in the Residency Research Network of Texas (RRNeT)
with support from the Dean’s Office, School of Medicine, UTHSCSA; the Texas
Academy of Family Physicians; the South Texas Area Health Education Center; the
National Center for Research Resources (Award # UL 1RR025767); and the Health
Resources and Services Administration (Award # D54HP16444). The content is
solely the responsibility of the authors and does not necessarily represent the
official views of the National Center for Research Resources of the National
Institutes of Health.
•Because depression and anxiety are so highly
prevalent in patients with chronic low back pain,
screening for depression and anxiety can help
physicians in their treatment of back pain. It is
possible that treating depression or anxiety could
decrease the need for opioids, and increase a
patient’s physical functioning.
References
1) Freburger JK, Holmes GM. The rising prevalence of chronic low back
pain. Arch Intern Med 2009; 169: 251-8.
(2) Anderson JA. Epidemiological aspects of back pain. Journal of the
Society of Occupational Medicine 1986;36:90-4.
(3) Currie SR, Wang J. Chronic back pain and major depression in the
Canadian population. Pain 2004;107:54–60.
(4) Bair MJ, Robinson RL. Depression and Pain Comorbidity. Arch Intern
Med 2003;163: 2433-2445.