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The Diabetic Foot-Pain-Depression Cycle.
Brandon M Brooks1, Chia-Ding Shih2, Bradley M Brooks3
1*The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH; Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC.
Journal of the American Podiatric Medical Association
|July 18, 2023
Summary
Patients with type 2 diabetes mellitus (T2DM) using antidepressants had significantly lower odds of needing opioids beyond seven days after forefoot amputation. This suggests a link between depression and diabetic foot pain management.
Area of Science:
- Podiatry
- Diabetology
- Pain Management
- Mental Health
Background:
- Over 86,000 Americans with type 2 diabetes mellitus (T2DM) undergo lower-extremity amputations annually.
- Opioid prescribing practices in podiatric surgery for T2DM patients are understudied.
- Antidepressant use may influence postoperative opioid duration in T2DM patients undergoing amputation.
Purpose of the Study:
- To investigate the association between antidepressant medication use and the duration of postoperative opioid use in patients with T2DM undergoing forefoot amputation.
- To identify factors influencing opioid use beyond 7 days in this patient population.
Main Methods:
- Retrospective cohort study of T2DM patients undergoing forefoot amputation (toe, ray, transmetatarsal).
- Inclusion criteria: Hemoglobin A1c < 8.0% and ankle-brachial index > 0.8.
- Logistic regression models analyzed the odds of opioid use beyond 7 days, considering variables like antidepressant use, age, race, sex, amputation level, BMI, and marital status.
Main Results:
- Fifty patients met the study criteria.
- Antidepressant use was a statistically significant factor associated with reduced opioid use.
- Patients using antidepressants had significantly decreased odds (OR, 0.018; P = .002) of using opioids beyond 7 days post-amputation, even after adjusting for marital status.
Conclusions:
- Antidepressant use is associated with significantly reduced long-term opioid use after forefoot amputation in T2DM patients.
- A potential diabetic foot-pain-depression cycle warrants consideration.
- Pre- and postoperative screening for depression and mental health referrals are recommended for podiatric surgeons treating T2DM patients undergoing amputation.
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