Kurt Kroenke and colleagues conducted a study to determine if a combined pharmacological and behavioural intervention improves both depression and pain in primary care patients with musculoskeletal pain and co-existing depression. The trial included 250 patients who had low back, hip, or knee pain for three months or longer and at least moderate depression severity. Patients were randomly assigned to the intervention or to usual care.
The intervention consisted of twelve weeks of optimised antidepressant therapy, managed by a nurse care manager; followed by six sessions of a pain self-management programme over twelve weeks - during each session, the nurse care manager introduces new strategies for patient self-management, assists the patient in choosing strategies, and supervises the patient as he/she practices the chosen strategy; and a six-month continuation phase, in which symptoms were monitored and treatments reinforced, with a focus on preventing relapse.
The researchers found that the intervention group had significantly better outcomes for depression. The intervention group was more than twice as likely to experience depression response (46 of 123 intervention patients versus 21 of 127 usual care patients) and nearly four times as likely to experience complete remission (17.9 percent versus 4.7 percent) at twelve months, corresponding to a much lower number of patients with major depression (40.7 percent versus 68.5 percent). Intervention patients were also much more likely than usual care patients to report overall improvement in their pain at twelve months (47.2 percent versus 12.6 percent).
The authors conclude: “Because pain and depression are among the leading causes of decreased work productivity, an intervention that is effective for both conditions may further strengthen a business model. Also, an intervention that allows a care manager to cover several conditions rather than a single disorder may enhance its implementation and cost-effectiveness.”
MEDICA.de; Source: American Medical Association (AMA)