Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial.
Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial.
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DOI：
10.1001/jama.2009.723
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发表时间：
2009-05-27
影响因子：
120.7
通讯作者：
Tu, Wanzhu
中科院分区：
文献类型：
--
作者：
Kroenke, Kurt;Bair, Matthew J.;Damush, Teresa M.;Wu, Jingwei;Hoke, Shawn;Sutherland, Jason;Tu, Wanzhu
Pain and depression are the most common physical and psychological symptoms in primary care, respectively. Moreover, they co-occur 30-50% of the time and have adverse reciprocal effects on quality of life, disability, and health care costs. To determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and comorbid depression. Randomized controlled trial conducted at 6 community-based clinics of 1 university primary care system and 5 general medicine clinics of 1 Department of Veterans Affairs Medical Center. Recruitment occurred from January 2005 to June 2007 and follow-up concluded in June 2008. The 250 patients had low back, hip or knee pain for ≥ 3 months and at least moderate depression severity (Patient Health Questionnaire-9 score ≥ 10). Patients were randomly assigned to the intervention (n=123) or to usual care (n=127). The intervention consisted of 12 weeks of optimized antidepressant therapy (step 1) followed by 6 sessions of a pain self-management (PSM) program over 12 weeks (step 2) and, lastly, a continuation phase of therapy for 6 months (step 3). Assessments at baseline, 1, 3, 6, and 12 months for depression (20-item Hopkins Symptom Checklist [HSCL-20]), pain severity and interference (Brief Pain Inventory [BPI]) and global improvement in pain. At 12 months, 46 (37.4%) of the 123 intervention patients had a 50% or greater reduction in depression severity from baseline compared with 21 (16.5%) of 127 usual care patients (relative risk [RR], 2.3; 95% CI, 1.5 to 3.2), corresponding to a much lower number with major depression (50 [40.7%] vs. 87 [68.5%]; RR, 0.6; 95% CI, 0.4-0.6). Also, a clinically significant (≥ 30%) reduction in pain was much more likely in intervention patients (51 [41.5%] vs. 22 [17.3%]; RR, 2.4; 95% CI, 1.6-3.2), as was global improvement in pain (58 [47.2%] vs. 16 [12.6%]; RR 3.7, 95% CI, 2.3-6.1). More intervention patients also experienced benefits in terms of our primary outcome, which was a combined improvement in both depression and pain (32 [26.0%] vs. 10 [7.9%]; RR = 3.3; 95% CI, 1.8 to 5.4). Optimized antidepressant therapy followed by a pain self-management program resulted in substantial improvement in depression as well as moderate reductions in pain severity and disability.
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