For patients who have comorbid depression and musculoskeletal pain, optimized antidepressant therapy combined with pain self-management may result in substantial improvements in both conditions. However, additional interventions may be needed to achieve bigger improvements in pain and higher depression response and remission rates.
Kroenke and colleagues studied 250 primary care patients who had had at least moderately severe low back, hip, or knee pain for at least 3 months and were at least moderately depressed. Patients were randomized to usual care or stepped care: 12 weeks of antidepressant therapy; then 6 sessions of pain self-management (social support, behavioral modification, relaxation techniques), practiced over 12 weeks; then 6 months of continuation and follow-up. The primary study outcomes were depression and pain severity at 1 year.
At 12 months, pain was reduced by at least 30% in 41.5% of the intervention group versus 17.3% of the usual-care group. Depression was cut by at least 50% in 37.4% of the stepped-care versus 16.5% of the usual-care group. More patients receiving stepped care (26%) rather than usual care (7.9%) also reported feeling both happier and more comfortable.
The authors noted that because pain and depression are leading causes of decreased work productivity, an intervention that is effective for both may be useful.
