Opioid exposure negatively affects early pain response in older venlafaxine-treated patients

Among older patients with chronic low back pain (CLBP) and depression who are treated with venlafaxine, exposure to opioids is associated with reduced likelihood of achieving early pain response but not that of attaining the combined pain/depression outcome, a study has shown.

Researchers performed secondary analyses of data collected from 227 older adults (age ≥65 years) with CLBP and depression and enrolled in a randomized clinical trial evaluating a stepped-care approach to comorbid pain and depression in older patients: the Addressing Depression and Pain Together study (ADAPT: 2010–2016).

All patients were given low-dose venlafaxine (≤150 mg/d) for 6 weeks. Pain and depression were evaluated weekly, and response for both pain and depression was defined by a ≥30-percent improvement on a 0–20 numeric rating scale for LBP and a Patient Health Questionnaire-9 score ≤5.

Results showed that opioid exposure did not improve pain responses and was associated with a 49-percent reduction in the likelihood of having a pain response with venlafaxine. On the other hand, exposure had no effect on the odds of experiencing either a depression response or the combined pain/depression outcome.

The present data provide reassurance that opioids do not prevent depression response, the researchers said. However, clinicians may want to consider either nonopioid or alternative antidepressant approaches to pain management in patients with CLBP and depression.

More studies are needed to investigate both longer duration of treatment and a wider range of doses, the researchers added.