BACKGROUNDWhile a number of pharmacological interventions exist for the treatment of opioid use disorder, evidence evaluating the effect of pain on substance use behavior, attrition rate, and physical or mental health among these therapies has not been well established. We aim to evaluate these effects using evidence gathered from a systematic review of studies evaluating chronic non-cancer pain (CNCP) in patients with opioid use disorder.METHODSWe searched the Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Dissertations and theses Database, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform Search Portal, and National Institutes for Health Clinical Trials Registry databases to identify articles evaluating the impact of pain on addiction treatment outcomes for patients maintained on opioid agonist therapy.RESULTSUpon screening 3,540 articles, 14 studies with a combined sample of 3,128 patients fulfilled the review inclusion criteria. Results from the meta-analysis suggest that pain has no effect on illicit opioid consumption [pooled odds ratio (pOR): 0.70, 95%CI 0.41–1.17; I2 = 0.0] but a protective effect for reducing illicit non-opioid substance use (pOR: 0.57, 95%CI 0.41–0.79; I2 = 0.0). Studies evaluating illicit opioid consumption using other measures demonstrate pain to increase the risk for opioid abuse. Pain is significantly associated with the presence of psychiatric disorders (pOR: 2.18; 95%CI 1.6, 2.9; I2 = 0.0%).CONCLUSIONCNCP may increase risk for continued opioid abuse and poor psychiatric functioning. Qualitative synthesis of the findings suggests that major methodological differences in the design and measurement of pain and treatment response outcomes are likely impacting the effect estimates.
Objective
There is increasing evidence of an association between depressive
symptoms and mild cognitive impairment (MCI) in cross-sectional studies, but
the longitudinal association between depressive symptoms and risk of MCI
onset is less clear. The authors investigated whether baseline symptom
severity of depression was predictive of time to onset of symptoms of
MCI.
Method
These analyses included 300 participants from the BIOCARD study, a
cohort of individuals who were cognitively normal at baseline (mean age
= 57.4 years) and followed for up to 20 years (mean follow-up
= 12.5 years). Depression symptom severity was measured using the
Hamilton Depression Scale (HAM-D). The authors assessed the association
between dichotomous and continuous HAM-D and time to onset of MCI within 7
years vs after 7 years from baseline (reflecting the mean time from baseline
to onset of clinical symptoms in the cohort) using Cox regression models
adjusted for gender, age, and education.
Results
At baseline, subjects had a mean HAM-D score of 2.2 (SD =
2.8). Higher baseline HAM-D scores were associated with an increased risk of
progression from normal cognition to clinical symptom onset ≤7 years
from baseline (p = 0.043), but not with progression >7 years
from baseline (p = 0.194). These findings remained significant after
adjustment for baseline cognition.
Conclusions
These results suggest that low levels of depressive symptoms may be
predictive of clinical symptom onset within approximately 7 years among
cognitively normal individuals, and may be useful in identifying persons
at-risk for MCI due to Alzheimer’s disease.
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