• Max Zubatsky, Matthew Witthaus, Jeffrey F Scherrer, Joanne Salas, Sarah Gebauer, Sandra Burge, and F David Schneider.
• Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
• Fam Pract. 2020 Jul 23; 37 (3): 348-354.

BackgroundDepression is associated with receipt of opioids in non-cancer pain.ObjectivesTo determine whether the receipt of opioid therapy modifies the relationship of depression and use of multiple non-opioid pain treatments.MethodsPatients (n = 320) with chronic low back pain (CLBP) were recruited from family medicine clinics and completed questionnaires that measured use of home remedies, physical treatments requiring a provider and non-opioid medication treatments. A binary variable defined use (yes/no) of all three non-opioid treatment categories. Depression (yes/no) was measured with the PHQ-2. The use of opioids (yes/no) was determined by medical record abstraction. Unadjusted and adjusted logistic regression models, stratified on opioid use, estimated the association between depression and use of all three non-opioid treatments.ResultsParticipants were mostly female (71.3%), non-white (57.5%) and 69.4% were aged 18 to 59 years. In adjusted analyses stratified by opioid use, depression was not significantly associated with using three non-opioid treatments (OR = 2.20; 95% CI = 0.80-6.07) among non-opioid users; but among opioid users, depression was significantly associated with using three non-opioid treatments (OR = 3.21; 95% CI: 1.14-8.99). These odds ratios were not significantly different between opioid users and non-users (P = 0.609).ConclusionThere is modest evidence to conclude that patients with CLBP and comorbid depression, compared with those without depression, were more likely to try both opioid and non-opioid pain treatments. Non-response to other pain treatments may partly explain why depression is associated with greater prescription opioid use.© The Author(s) 2019. Published by Oxford University Press. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.

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