Presenter Information

Elizabeth SwansonFollow

Start Date

17-11-2017 10:00 AM

End Date

17-11-2017 11:30 AM

Description

Background: Complexity of treatment of older adults frequently suffering from comorbid chronic pain and depression necessitates a further understanding of how best to focus treatment for these conditions to increase functional ability, quality of life, social, physical, and emotional well-being. Nurse practitioners should be aware of how to best treat these patients. The question whether to treat the pain directly, treat the depression, or using combined treatment for both conditions is a barrier to effective treatment by clinicians.

Objectives: The purpose of this research is to compare the pharmacological treatment strategies and explore their differences, similarities, and effectiveness in improving comorbid pain and depression in older adults.

Method: The framework used for the integrative literature review was established by Whitmore and Knafl (2005). The databases used in the research were CINAHL, PsycInfo, and PubMed. Two separate searches were performed to obtain literature on both opioids and antidepressants in relation to pain and depression. Both literature searches were limited to full text articles, primary sources, research articles, English language, age group 65+, and publication dates 2006 through 2017. A total of seven studies were included in the analysis and met the inclusion and exclusion criteria that focused on mean age 55 or older and treatment with either an opioid or antidepressant. The inclusion of a pain and depression scale was a focus of all seven studies as well.

Results: The literature demonstrated support for the use of antidepressants, duloxetine and venlafaxine, for treatment of comorbid chronic pain associated with musculoskeletal conditions, neuropathy, and arthritis in depressed older adults. The research also points to length of medication use and consistency of use as better predictors of positive outcome versus the superiority of a single antidepressant. Although the findings show transdermal opioids as safe and effective for older adults with comorbid chronic pain and depression, the use of oral opioids may actually increases rates of depression in those older adults using them for the pain.

Signs of early improvement in pain and depression may be a reliable measure of progress to gauge continued response to treatment. The improvement of pain and depression occurs simultaneously but at different rates and may be affected by the cause of the chronic pain. The effective treatment of both chronic pain and depression can have other benefits such as increased functional ability, better general health, and increased quality of life.

Conclusion: Both antidepressants and opioids for the treatment of chronic pain and depression present potential risks but also many benefits making them effective treatment options. Future research should be focused on the exclusive study of older adults with chronic pain and depression, single medication use without adjunct therapies, and comparison studies of antidepressants vs opioids for treatment of older adults with these conditions.

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Nov 17th, 10:00 AM Nov 17th, 11:30 AM

Opioid vs Antidepressant Efficacy in Treatment of Comorbid Chronic Pain and Depression in Older Adults: An Integrative Literature Review

Background: Complexity of treatment of older adults frequently suffering from comorbid chronic pain and depression necessitates a further understanding of how best to focus treatment for these conditions to increase functional ability, quality of life, social, physical, and emotional well-being. Nurse practitioners should be aware of how to best treat these patients. The question whether to treat the pain directly, treat the depression, or using combined treatment for both conditions is a barrier to effective treatment by clinicians.

Objectives: The purpose of this research is to compare the pharmacological treatment strategies and explore their differences, similarities, and effectiveness in improving comorbid pain and depression in older adults.

Method: The framework used for the integrative literature review was established by Whitmore and Knafl (2005). The databases used in the research were CINAHL, PsycInfo, and PubMed. Two separate searches were performed to obtain literature on both opioids and antidepressants in relation to pain and depression. Both literature searches were limited to full text articles, primary sources, research articles, English language, age group 65+, and publication dates 2006 through 2017. A total of seven studies were included in the analysis and met the inclusion and exclusion criteria that focused on mean age 55 or older and treatment with either an opioid or antidepressant. The inclusion of a pain and depression scale was a focus of all seven studies as well.

Results: The literature demonstrated support for the use of antidepressants, duloxetine and venlafaxine, for treatment of comorbid chronic pain associated with musculoskeletal conditions, neuropathy, and arthritis in depressed older adults. The research also points to length of medication use and consistency of use as better predictors of positive outcome versus the superiority of a single antidepressant. Although the findings show transdermal opioids as safe and effective for older adults with comorbid chronic pain and depression, the use of oral opioids may actually increases rates of depression in those older adults using them for the pain.

Signs of early improvement in pain and depression may be a reliable measure of progress to gauge continued response to treatment. The improvement of pain and depression occurs simultaneously but at different rates and may be affected by the cause of the chronic pain. The effective treatment of both chronic pain and depression can have other benefits such as increased functional ability, better general health, and increased quality of life.

Conclusion: Both antidepressants and opioids for the treatment of chronic pain and depression present potential risks but also many benefits making them effective treatment options. Future research should be focused on the exclusive study of older adults with chronic pain and depression, single medication use without adjunct therapies, and comparison studies of antidepressants vs opioids for treatment of older adults with these conditions.

 

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