Magazine article Clinical Psychiatry News

Program Reduces Depression, Chronic Pain

Magazine article Clinical Psychiatry News

Program Reduces Depression, Chronic Pain

Article excerpt

A program of optimized pharmacologic therapy and pain self-management in patients with co-morbid depression and chronic pain produced substantial and sustained reductions in disability and depression and pain severity.

The program, which was assessed in a study of 250 patients, was implemented in two primary care clinic systems by a nurse care-manager supervised by a physician, reported Dr. Kurt Kroenke of the divisions of internal medicine and geriatrics, Indiana University, Indianapolis, and his associates (JAMA 2009;301:2099-110).

They conducted the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study to determine whether two types of treatment--pharmacologic and behavioral--would prove synergistic in treating the comorbid conditions.

The subjects were men and women who had moderately severe or worse depression and moderately severe or worse chronic pain in the back, hip, or knee that had persisted for at least 3 months despite conventional analgesic therapy. The mean age of the participants was 55 years.

A total of 123 subjects were randomly assigned to receive the study intervention: 3 months of optimized antidepressant therapy, followed by an additional 3 months of pain self-management instruction, followed by 6 months of relapse prevention. The authors noted that the trial "was not designed to test any particular antidepressant but instead analyzed optimal mediation management, which is both effective and tolerated in an individual patient." The remaining 127 subjects served as a control group, receiving usual care.

The pain self-management program included at least five in-person and eight telephone contacts during which patients learned about "chronic pain triggers and flare-ups; coping with fear and other negative emotions; and strategies for physical activity, muscle relaxation, deep breathing, distraction, sleep hygiene, and working with clinicians and employers" to manage their disability, the authors wrote. …

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