Pain diagnoses and pain medication prescriptions before, during and after major depression diagnosis: A nationwide cohort of 521,244 people with new onset depression

BACKGROUND: Chronic pain and major depressive disorder (MDD) are prevalent and often co-occurring conditions, yet the temporal relationship between pain management and the onset of MDD remains inadequately understood.

METHODS: This study analyzed data from 521,244 individuals with incident MDD between 2011 and 2020, utilizing Taiwan's National Health Insurance Research Database. We examined prescriptions for analgesics, including acetaminophen, NSAIDs, opioids, and gabapentinoids, and categorized pain diagnoses as inflammatory, degenerative, neuropathic, chronic, or headache-related. Data were collected for 12 months before and after the incident MDD diagnosis. Interrupted time-series analysis was employed to model temporal trends in medication use and diagnoses.

RESULTS: Findings revealed a notable increase in both pain diagnoses and analgesic prescriptions leading up to the MDD diagnosis, peaking at the index month. Specifically, opioid use reached a prevalence of 3.38 %, acetaminophen 21.67 %, NSAIDs 23.72 %, and gabapentinoids 0.86 %. Headache disorders were present in 2.58 % of patients, and chronic pain was noted in 2.07 %. Following the MDD diagnosis, there was a significant immediate decline in analgesic use, NSAIDs (OR = 0.92, 95 % CI [0.91, 0.92]) and opioids (OR = 0.90, [0.88, 0.92]), with a continued downward trend over the subsequent year. Fibromyalgia and headache disorders demonstrated the strongest associations with the onset of MDD.

CONCLUSIONS: These patterns suggest that escalating pain and analgesic use may serve as prodromal indicators of MDD, and psychiatric interventions post-diagnosis may reduce reliance on pain medications. Integrating pain and mental health assessments in primary care could facilitate earlier treatment, potentially mitigating the compounded burden of these conditions.