Treating Concurrent Chronic Low Back Pain and Depression with Low-Dose Venlafaxine: An Initial Identification of "Easy-to-Use" Clinical Predictors of Early Response

Soham Rej, Mary Amanda Dew, Jordan F. Karp

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Objective: Depression and chronic low back pain (CLBP) are both frequent and commonly comorbid in older adults seeking primary care. Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine may be effective in treating comorbid depression and CLBP. For patients with comorbid depression and CLBP, our goal was to identify "easy-to-use" early clinical variables associated with response to 6 weeks of low-dose venlafaxine pharmacotherapy that could be used to construct a clinically useful predictive model in future studies. Methods: We report data from the first 140 patients completing phase 1 of the Addressing Depression and Pain Together clinical trial. Patients aged ≥60 with concurrent depression and CLBP received 6 weeks of open-label venlafaxine 150mg/day and supportive management. Using univariate and multivariate methods, we examined a variety of clinical predictors and their association with response to both depression and CLBP; change in depression; and change in pain scores at 6 weeks. Results: About 26.4% of patients responded for both depression and pain with venlafaxine. Early improvement in pain at 2 weeks predicted improved response rates (P=0.027). Similarly, positive changes in depression and pain at 2 weeks independently predicted continued improvement at 6 weeks in depression and pain, respectively (P<0.001). Conclusions: An important minority of patients benefitted from 6 weeks of venlafaxine 150mg/day. Early improvement in depression and pain at 2 weeks may predict continued improvement at week 6. Future studies must examine whether patients who have a poor initial response may benefit from increasing the SNRI dose, switching, or augmenting with other treatments after 2 weeks of pharmacotherapy.

Original languageEnglish (US)
Pages (from-to)1154-1162
Number of pages9
JournalPain Medicine (United States)
Volume15
Issue number7
DOIs
StatePublished - Jul 2014
Externally publishedYes

Keywords

  • Back Pain
  • Clinical Trial
  • Depression
  • Geriatrics
  • Predictors of Response
  • Primary Care
  • Venlafaxine

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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