Pain and depression are the most common physical and psychological complaints in primary care. The two conditions occur together approximately 30 to 50% of the time, with adverse effects on quality of life, disability, and health care costs. In the May 27, 2009 issue of the Journal of the American Medical Association, researchers report that optimized antidepressant therapy followed by a pain self-management program significantly improves depression and also reduces pain and disability.

Researchers from the Indiana University School of Medicine and their colleagues recruited 250 people with moderately severe depression who had at least 3 months of low back, hip, or knee pain in order to determine if combining medications and behavioral interventions would reduce pain and depression in primary care patients who were suffering from both conditions. The study participants were randomly assigned to either usual care or an intervention consisting of 12 weeks of optimized antidepressant therapy followed by a pain self-management program and then a 6-month continuation phase of therapy. The researchers found that, at 12 months, over 37% of the patients assigned to the intervention had at least a 50% reduction in depression severity, as compared to 16.5% of the patients assigned to usual care. Intervention patients were also more likely to report a clinically significant reduce in pain and a combined improvement in both depression and pain.

Pain complaints comprise more than 40% of all symptom-related outpatient visits, and depression is present in 10 to 15% of all patients attending primary care. In the United States, musculoskeletal pain accounts for nearly 70 million outpatient visits each year. The findings of this study suggest that there may be a synergistic effect between medication and behavioral interventions for the treatment of pain and depression. The authors also suggest that additional interventions, such as optimized analgesic therapy or cognitive behavioral therapy, might be needed to produce even large improvements in depression severity and pain.

Source:

JAMA. 2009;301(20):2099-2110.