Intervention Brings Relief for Patients With Pain, Depression

An intervention in the form of antidepressant therapy and a pain self-management program could help victims suffering from pain and depression, according to a new study.

Kurt Kroenke, M.D., of Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, and colleagues conducted a study to determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and co-existing depression.

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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 said.

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.

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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.

"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," the authors said.

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"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.

The study appears in the May 27 issue of JAMA.

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