People with depression get strong painkillers, but do they work?

If you have chronic pain, such as back or neck aches, and also suffer from depression, you may want to think twice about the treatment your doctor has prescribed.

A new study shows that people with chronic aches who are also depressed are more likely than others to get a potent painkiller, such as morphine or codeine, but there’s no evidence these drugs are effective or safe for those who suffer from depression. The medicines also pose a risk of addiction and serious side effects.

In the study, which appears in the November-December issue of General Hospital Psychiatry, researchers examined medical records of more than 14,000 people who were prescribed opioids for three months or longer between 1997 and 2005 for chronic pain. The result: people with a history of depression were three times more likely to have been prescribed the potent painkillers. They were also more likely to receive a higher dose, and to be put on opioids that carry a higher potential for abuse or addiction, such as morphine and oxycodone (OxyContin, Percocet, and others, including generics).

Depression and pain often go hand in hand. It’s not uncommon that many people who see specialists to treat their chronic pain also have a history of depression. At the same time, their pain tends to resist treatment, so they often end up taking opioids, such as codeine or hydrocodone (Vicodin and others, including generics), which are strong painkillers and should be a last resort. The trouble is that clinical trials to test opioid drugs have typically excluded people with depression because they’re vulnerable to becoming addicted. So it’s unknown how well opioids even work, if at all, or if they are safe for people with depression to take. It’s also not known whether opioids are effective or safe for long-term use in general, because most studies have lasted for only a few weeks or months.

The researchers said another concern is that opioids may mask depression symptoms and distract people from getting treatment, such as psychotherapy and antidepressant medicines, that could help alleviate their depression.

In our Best Buy Drug report on opioids, for people with chronic pain, we recommend trying less risky pain relievers such as acetaminophen (Tylenol or generics), ibuprofen (Advil or generics), or naproxen (Aleve or generics) before opting for an opioid. And for more information about depression and drug treatments, see our Best Buy Drug report on antidepressants.

—Steve Mitchell, associate editor, Consumer Reports Best Buy Drugs

For more on understanding and treating depression, see the risk factors and our comparison of 18 drug and non-drug treatments (subscribers only), including counseling, St. John's wort, and SSRIs.

Comments

[Chandan]

Here's something else to consider... 30% of psychiatry patients have somatic issues, most likely "pain." Yes, opioids are better for pain. But a large chunk of people getting pain pills (i.e. chronic pain pills) have complex psychologic issues that are better treated with psychotherapy than pain pills. I know this from personal experience working in primary care, psychiatry, and also pain clinics.

[Alison]

This is ridiculous. Chronic pain and depression go hand in hand. Drugs such as Ibuprofin, Acetaminophen or Naproxen are totally ineffective on chronic pain. I know from experience. Even Vicodin, after a long time, loses effectiveness. That is all I was given for over 20 yrs. Doctors told me they couldn't do anything about my back, so they just threw Vicodin at me. Now I am on Fentanyl patches (opioids) and now that I have relief, my depression has lifted a bit. Relieve the pain, relieve the depression.

[Sanjeev]

Opioids also cause depression, so it is possible that people on potent narcotics get depressed and are more likely to take anti-depressants to combat the depression.