Combination therapy works for pain-associated depression

‘Pain and depression are the most common physical and psychological symptoms in primary care, respectively. Moreover, they co-occur 30% to 50% of the time,’ the study authors said.

They assessed the effect of a combined intervention on 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.

The combination therapy consisted of 12 weeks of tailored antidepressant therapy and a 12-week pain self-management programme, both carried out by a nurse. This was followed by a six-month continuation phase, in which patients received calls from the nurse to assess symptoms and to evaluate adherence to the intervention.

Subjects were randomised to the intervention or usual care. The authors found the intervention group was more than twice as likely to experience a reduction in depression – 37.4% of intervention patients versus 16.5% of controls – and nearly four times as likely to experience complete remission after 12 months – 17.9% versus 4.7%.

Intervention patients were also much more likely than controls to report overall improvement in their pain at 12 months – 47.2% versus 12.6%.

‘It is possible that pain improvement in our trial reflected a main effect of improved mood, and that as depression lifts, patients may experience pain as being less intense and less disabling,’ the authors said in the Journal of the American Medical Association.

‘Conversely, it is also possible that the improvement in depression was mediated by an improvement in pain or that both depression and pain lessened as a result of treatment effects on a common pathway,’ they added.

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