Tailored Treatments Effective for Depression Due to Pain
TUESDAY May 26, 2009 -- Combined drug and behavioral interventions helped reduce pain and depression in patients with musculoskeletal pain and coexisting depression, a U.S. study finds.
The study included 250 patients who'd had low back, hip or knee pain for three months or longer, and at least moderate depression. The patients were randomly assigned to either an intervention or usual-care group.
Patients in the intervention group received 12 weeks of individually tailored antidepressant therapy, followed by six sessions of a pain self-management program. This was followed by a six-month period in which their symptoms were monitored and treatments reinforced with the goal of preventing relapse, the study authors explained.
After 12 months, intervention group participants were more likely to report overall improvement in their pain compared with usual care patients (47.2 percent vs. 12.6 percent), twice as likely to experience depression response (37.4 percent vs. 16.5 percent), nearly four times as likely to experience complete remission of depression (17.9 percent vs. 4.7 percent), and less likely to have major depression (40.7 percent vs. 68.5 percent), the researchers found.
Intervention group patients were also more likely to experience a composite response at six months (23.6 percent vs. 7.9 percent) and at 12 months (26 percent vs. 7.9 percent). A composite response is defined as a reduction of 50 percent or more in depression and reduction of 30 percent or more in pain.
The study appears in the May 27 issue of the Journal of the American Medical Association.
"It is possible that pain improvement in our trial reflected a main effect of improved mood [i.e., an antidepressant effect on mood rather than an analgesic effect], and that as depression lifts, patients may experience pain as being less intense and less disabling," wrote Dr. Kurt Kroenke, of the Indiana University School of Medicine and the Regenstrief Institute in Indianapolis, and colleagues.
"Conversely, it is also possible that the improvement in depression was mediated by an improvement in pain [i.e., as pain improves, patients feel less depressed] or that both depression and pain lessened as a result of treatment effects on a common pathway," they added.