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Three-Step Program Helps Manage Depression and Pain

Last Updated: May 26, 2009.

In patients with depression and chronic pain, an optimized three-step intervention may lead to significant improvements in both conditions, according to a study published in the May 27 issue of the Journal of the American Medical Association.

TUESDAY, May 27 (HealthDay News) -- In patients with depression and chronic pain, an optimized three-step intervention may lead to significant improvements in both conditions, according to a study published in the May 27 issue of the Journal of the American Medical Association.

Kurt Kroenke, M.D., of the Regenstrief Institute Inc. in Indianapolis, and colleagues from the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) trial randomly assigned 250 patients with chronic low back, hip, or knee pain and at least moderate depression severity to receive either usual care or a three-step intervention that included 12 weeks of optimized antidepressant therapy, six sessions of a pain self-management program over the next 12 weeks, and a six-month continuation phase.

After one year, the researchers found that a significantly higher number of intervention patients achieved the primary outcome, which was a combined improvement in both depression and pain (26 versus 7.9 percent). They also found that the intervention was associated with a lower rate of major depression (40.7 versus 68.5 percent) and a higher rate of pain reduction (41.5 versus 17.3 percent).

"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," the authors conclude. "Also, an intervention that allows a care manager to cover several conditions rather than a single disorder may enhance its implementation and cost-effectiveness. Given the prevalence, morbidity, disability, and costs of the pain-depression dyad, the SCAMP trial results have important implications."

Authors of the study reported financial relationships with the pharmaceutical industry.

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