Posted by SLS on October 30, 2010, at 16:37:08
In reply to Re: Thinking of coming off meds NO WAY! » SLS, posted by floatingbridge on October 30, 2010, at 14:46:55
> I think I'm having a bad morning, but I felt maybe the list from you was sent to me with anger or frustration.... Maybe because I haven't figured this out for myself by now? And if this is pure projection on my part, I'm sorry.
You are such a silly thing.
:-)
I'm sorry for not writing anything along with the links. I really didn't have the energy at the time. I just wanted you to see the associations between depression and pain before the thread died. Anxiety, insomnia, and fatigue are often contributory to the presentation of this type of pain in depression.
- Scott
Depression, Musculoskeletal Pain May Respond to Antidepressant Therapy, Pain Self-ManagementJune 16, 2009 Optimized antidepressant therapy followed by a pain self-management program is associated with substantial improvement in depression as well as moderate reductions in pain severity and disability, according to the results of a randomized controlled trial reported in the May 27 issue of the Journal of the American Medical Association.
"Two types of treatment (one pharmacological and the other behavioral) could prove synergistic in the treatment of comorbid musculoskeletal pain and depression," write Kurt Kroenke, MD, from Regenstrief Institute Inc, in Indianapolis, Indiana, and colleagues. "Antidepressants are a well-established therapy for depression, and there is also evidence for at least moderate efficacy in pain, which may vary by type of painful disorder and antidepressant class. Pain self-management programs have proven efficacious for both low back pain and osteoarthritis."
The goal of this study was to assess the effects of a combined pharmacologic and behavioral intervention on depression and pain in primary care patients with musculoskeletal pain and comorbid depression. The Stepped Care for Affective Disorders and Musculoskeletal Pain study was conducted at 6 community-based clinics and 5 Veterans Affairs general medicine clinics in Indianapolis, Indiana, with enrollment of 250 patients from January 2005 to June 2007 and follow-up completed in June 2008.
Inclusion criteria were low back, hip, or knee pain for at least 3 months and depression severity at least moderate based on a Patient Health Questionnaire 9 score of 10 or higher. Patients were randomly assigned to receive usual care (n = 127) or an intervention (n = 123) consisting of 12 weeks of optimized antidepressant therapy (step 1) followed by 6 sessions of a pain self-management program for 12 weeks (step 2) and a continuation phase of therapy for 6 months (step 3).
Study assessments included depression, measured with the 20-item Hopkins Symptom Checklist, pain severity and interference measured with the Brief Pain Inventory, and global improvement in pain at 12 months.
At 12 months, the intervention group had a much lower number of patients with major depression (50 [40.7%]) vs the standard care group (87 [68.5%]; relative risk [RR], 0.6; 95% confidence interval [CI], 0.4 - 0.8). Reduction in depression severity from baseline of 50% or greater occurred in 46 (37.4%) of the 123 intervention patients and in 21 (16.5%) of 127 usual-care patients (RR, 2.3; 95% CI, 1.5 - 3.2).
The intervention group also fared better in a greater likelihood of clinically significant (= 30%) pain reduction (51 intervention patients [41.5%] vs 22 usual-care patients [17.3%]; RR, 2.4; 95% CI, 1.6 - 3.2) and in global improvement in pain (58 [47.2%] vs 16 [12.6%], respectively; RR, 3.7; 95% CI, 2.3 - 6.1). The primary outcome of combined improvement in both depression and pain occurred in 32 intervention patients (26.0%) vs 10 usual-care patients (7.9%; RR, 3.3; 95% CI, 1.8 - 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," the study authors write. "Additional interventions may be needed to produce larger improvements in pain and higher depression response and remission rates."
Limitations of this study include possible ascertainment bias, inability to determine the effect of the pain management program alone, inability to compare the efficacy of different antidepressants, limited generalizability to other patient groups, and some discordance between patient self-report and electronic medical record data.
"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 study authors write. "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 [Stepped Care for Affective Disorders and Musculoskeletal Pain] trial results have important implications."
The National Institute of Mental Health supported this study. Two of the study authors have disclosed various financial relationships with Eli Lilly, Pfizer, Wyeth, Astra-Zeneca, Forest Laboratories. Abbott, and/or Cephalon.
JAMA. 2009;301:2099-2110.
Some see things as they are and ask why.
I dream of things that never were and ask why not.
poster:SLS
thread:965683
URL: http://www.dr-bob.org/babble/20101030/msgs/967680.html