{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:47Z","timestamp":1783509287272,"version":"3.55.0"},"reference-count":71,"publisher":"MDPI AG","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    More than 86,000 Americans with type 2 diabetes mellitus (T2DM) undergo nontraumatic lower-extremity amputations annually. The opioid-prescribing practice of podiatric surgeons remains understudied. We hypothesized that patients with T2DM who undergo any forefoot amputation while using antidepressant medication will have reduced odds of using opioids beyond 7 days.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    We completed a retrospective cohort study examining patients with T2DM who underwent forefoot amputation (toe, ray, transmetatarsal). Data were restricted to patients with a hemoglobin A\n                    <jats:sub>1c<\/jats:sub>\n                    level less than 8.0% and an ankle-brachial index greater than 0.8. The outcome was use of postoperative opioids beyond 7 days. Patients received an initial opioid prescription of 7 days or less. We developed simple logistic regression models to identify the odds of a patient using opioids beyond 7 days by patient variables: age, race, sex, amputation level, body mass index, antidepressant medication use, and marital status. Variables with\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .1 in the univariate analysis were included in the multiple logistic regression model.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Fifty patients met the inclusion criteria. Antidepressant use and marital status were the only statistically significant variables. Adjusting for marital status, patients with antidepressant use had decreased odds (odds ratio, 0.018; 95% confidence interval, 0.001\u20130.229;\n                    <jats:italic>P<\/jats:italic>\n                    = .002) of using opioids beyond 7 days after a diabetic forefoot amputation.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Patients with T2DM who used antidepressants had significantly reduced odds of using opioids beyond 1 week after forefoot amputations compared with those without antidepressant use. We proposed an underlying diabetic foot\u2013pain\u2013depression cycle. To break the cycle, podiatric surgeons should screen this population for depression preoperatively and postoperatively and not hesitate to make a mental health referral if warranted. Nontraumatic amputations can be a traumatic experience for patients; psychiatrists and other mental health providers should be members of limb preservation teams.\n                  <\/jats:p>","DOI":"10.7547\/22-126","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T13:48:12Z","timestamp":1689601692000},"source":"Crossref","is-referenced-by-count":16,"title":["The Diabetic Foot\u2013Pain\u2013Depression Cycle"],"prefix":"10.3390","volume":"113","author":[{"given":"Brandon M.","family":"Brooks","sequence":"first","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH; Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Ding","family":"Shih","sequence":"additional","affiliation":[{"name":"California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley M.","family":"Brooks","sequence":"additional","affiliation":[{"name":"University of South Alabama Health, Mobile, AL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dyane E.","family":"Tower","sequence":"additional","affiliation":[{"name":"American Podiatric Medical Association, Bethesda, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany T.","family":"Tran","sequence":"additional","affiliation":[{"name":"California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet E.","family":"Simon","sequence":"additional","affiliation":[{"name":"New Mexico Foot & Ankle Institute, Albuquerque, NM."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of University of Southern California, Los Angeles, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"BMJ","first-page":"n2865","article-title":"A record 100\u2009000 people in the US died from overdoses in 12 months of the pandemic, says CDC","volume":"375","author":"Dyer O","year":"2021","unstructured":"Dyer O: A record 100\u2009000 people in the US died from overdoses in 12 months of the pandemic, says CDC. 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