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Antidepressants combined with self-management of pain improves outcomes in people with comorbid pain and depression

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Question

Question:

What is the effect of a combined pharmacological and behavioural intervention on depression and pain symptoms in people with musculoskeletal pain and comorbid depression?

Patients:

250 adults (mean age 55.5 years, 53% female) with depression and musculoskeletal pain in the hip, low back or knee persisting for 3 months or more despite using >2 different analgesics. Pain scores had to be at least of moderate severity, scoring >5 on the Brief Pain Inventory Score (BPI). Severity of depression had to be at least moderate, scoring >10 on the Patient Health Questionnaire-9 (PHQ-9). Exclusions included bipolar disorder, severe cognitive impairment, substance use disorder or schizophrenia.

Setting:

Six community based primary care clinics and five Veterans Affairs general medicine clinics, Indiana, USA; recruitment January 2005–June 2007.

Intervention

The intervention consisted of three steps. Step 1: 12 weeks of optimised antide press ant therapy, actively managed by a nurse care manager. Clinical response was assessed at 3 weeks and doses increased if a 5 point drop in the PHQ-9 score was not apparent. Participants were switched to a different …

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