Integrated Care for Depression and Chronic Back Pain

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DESCRIPTION (provided by applicant): Research Goal: Our long-term goal is to improve the functional, symptom and cost of care outcomes among patients with co-morbid depression and chronic pain. This proposal seeks support for a pilot study of an integrated intervention for depression and chronic back pain. The proposed pilot study will accomplish the following specific aims: Aim 1: Develop an integrated intervention for chronic back pain patients with major depression. This research will develop an integrated, biopsychosocial intervention for chronic back pain patients with major depression. The integrated intervention incorporates proven interventions for major depression (Problem-Solving Therapy and/or antidepressant medications depending on patient preferences) with brief cognitive-behavioral interventions for chronic back pain, also of proven effectiveness. Aim 2: Develop methods for inducing and assessing intervention fidelity. We will assess the delivery, receipt and enactment of the integrated intervention with multiple methods (provider ratings, patient ratings, patient logs, and independent ratings of audiotapes). We will assess the inter-rater reliability of independent ratings of audiotapes, the convergent validity of fidelity measures obtained from different sources, and the correlation of different components of intervention fidelity. Aim 3: Conduct a pilot test of the integrated intervention for depressed chronic back pain patients. We will conduct a pilot test of the integrated intervention with 50 intervention and 50 care as usual control patients. The pilot RCT will assess screening completion and eligibility rates; participation in the integrated intervention among patients randomly assigned to the intervention arm; the fidelity of provider delivery and patient receipt of the intervention; levels of patient enactment of the intervention as assessed by measures of patient adherence with pharmacologic and behavioral treatments; acceptability of the integrated intervention to participating primary care physicians; and intervention effect size at 6 months for pain, depression and functional outcomes. We will assess the incremental benefit of integrated management of depression and chronic back pain relative to brief cognitive-behavioral intervention for back pain alone (through comparison of intervention patients to historical controls receiving only a cognitive-behavioral intervention for chronic back pain).