Impact of depression on 12-month outcomes in primary-care patients with chronic musculoskeletal pain

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Abstract

Objectives Depression complicates chronic pain in 3050 percent of patients. Our objectives were to determine the 12-month clinical outcomes in patients with chronic musculoskeletal pain and the effects of comorbid depression.Methods A cohort of 377 primary care patients with low back, hip, or knee pain for at least three months were enrolled, including 127 with depression of at least moderate severity [Patient Health Questionnaire-9 score≥10] and 250 without depression. Telephone assessments were done at baseline, three, and 12 months by interviewers blinded to group status. Outcomes included pain severity, pain self-efficacy, disability, and pain-specific health care use, as well as depression, anxiety, somatization, stress, and quality of life.Results Patients with comorbid depression had moderately greater pain severity and substantially worse pain-related disability as well as greater impairment across multiple symptom and health-related quality of life domains. This adverse effect of depression persisted at three- and 12-month follow-up. Rates of improvement in pain were low and did not differ between groups [16.5 versus 19.8 percent], but depressed patients were significantly more likely to report worsening of pain at 12 months [35.0 versus 18.5 percent, P<0.0001]. Development of incident depression was uncommon. Self-reported pain-specific treatments and healthcare use were similar in the two groups.Conclusions Patients with chronic pain and comorbid depression have substantially worse disability and health-related quality of life, which persists over long-term follow-up. Diligent efforts to identify and treat depression could potentially improve pain.

Original languageEnglish (US)
Pages (from-to)8-17
Number of pages10
JournalJournal of Musculoskeletal Pain
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2012

Fingerprint

Musculoskeletal Pain
Chronic Pain
Primary Health Care
Depression
Pain
Quality of Life
Delivery of Health Care
Self Efficacy
Telephone
Hip
Knee
Anxiety
Interviews

Keywords

  • Depression
  • Disability
  • Pain
  • Primary care
  • Prognosis
  • Quality of life

ASJC Scopus subject areas

  • Rheumatology

Cite this

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title = "Impact of depression on 12-month outcomes in primary-care patients with chronic musculoskeletal pain",
abstract = "Objectives Depression complicates chronic pain in 3050 percent of patients. Our objectives were to determine the 12-month clinical outcomes in patients with chronic musculoskeletal pain and the effects of comorbid depression.Methods A cohort of 377 primary care patients with low back, hip, or knee pain for at least three months were enrolled, including 127 with depression of at least moderate severity [Patient Health Questionnaire-9 score≥10] and 250 without depression. Telephone assessments were done at baseline, three, and 12 months by interviewers blinded to group status. Outcomes included pain severity, pain self-efficacy, disability, and pain-specific health care use, as well as depression, anxiety, somatization, stress, and quality of life.Results Patients with comorbid depression had moderately greater pain severity and substantially worse pain-related disability as well as greater impairment across multiple symptom and health-related quality of life domains. This adverse effect of depression persisted at three- and 12-month follow-up. Rates of improvement in pain were low and did not differ between groups [16.5 versus 19.8 percent], but depressed patients were significantly more likely to report worsening of pain at 12 months [35.0 versus 18.5 percent, P<0.0001]. Development of incident depression was uncommon. Self-reported pain-specific treatments and healthcare use were similar in the two groups.Conclusions Patients with chronic pain and comorbid depression have substantially worse disability and health-related quality of life, which persists over long-term follow-up. Diligent efforts to identify and treat depression could potentially improve pain.",
keywords = "Depression, Disability, Pain, Primary care, Prognosis, Quality of life",
author = "Kurt Kroenke and Jingwei Wu and Bair, {Matthew J.} and Damush, {Teresa M.} and Krebs, {Erin E.} and Wanzhu Tu",
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AU - Kroenke, Kurt

AU - Wu, Jingwei

AU - Bair, Matthew J.

AU - Damush, Teresa M.

AU - Krebs, Erin E.

AU - Tu, Wanzhu

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N2 - Objectives Depression complicates chronic pain in 3050 percent of patients. Our objectives were to determine the 12-month clinical outcomes in patients with chronic musculoskeletal pain and the effects of comorbid depression.Methods A cohort of 377 primary care patients with low back, hip, or knee pain for at least three months were enrolled, including 127 with depression of at least moderate severity [Patient Health Questionnaire-9 score≥10] and 250 without depression. Telephone assessments were done at baseline, three, and 12 months by interviewers blinded to group status. Outcomes included pain severity, pain self-efficacy, disability, and pain-specific health care use, as well as depression, anxiety, somatization, stress, and quality of life.Results Patients with comorbid depression had moderately greater pain severity and substantially worse pain-related disability as well as greater impairment across multiple symptom and health-related quality of life domains. This adverse effect of depression persisted at three- and 12-month follow-up. Rates of improvement in pain were low and did not differ between groups [16.5 versus 19.8 percent], but depressed patients were significantly more likely to report worsening of pain at 12 months [35.0 versus 18.5 percent, P<0.0001]. Development of incident depression was uncommon. Self-reported pain-specific treatments and healthcare use were similar in the two groups.Conclusions Patients with chronic pain and comorbid depression have substantially worse disability and health-related quality of life, which persists over long-term follow-up. Diligent efforts to identify and treat depression could potentially improve pain.

AB - Objectives Depression complicates chronic pain in 3050 percent of patients. Our objectives were to determine the 12-month clinical outcomes in patients with chronic musculoskeletal pain and the effects of comorbid depression.Methods A cohort of 377 primary care patients with low back, hip, or knee pain for at least three months were enrolled, including 127 with depression of at least moderate severity [Patient Health Questionnaire-9 score≥10] and 250 without depression. Telephone assessments were done at baseline, three, and 12 months by interviewers blinded to group status. Outcomes included pain severity, pain self-efficacy, disability, and pain-specific health care use, as well as depression, anxiety, somatization, stress, and quality of life.Results Patients with comorbid depression had moderately greater pain severity and substantially worse pain-related disability as well as greater impairment across multiple symptom and health-related quality of life domains. This adverse effect of depression persisted at three- and 12-month follow-up. Rates of improvement in pain were low and did not differ between groups [16.5 versus 19.8 percent], but depressed patients were significantly more likely to report worsening of pain at 12 months [35.0 versus 18.5 percent, P<0.0001]. Development of incident depression was uncommon. Self-reported pain-specific treatments and healthcare use were similar in the two groups.Conclusions Patients with chronic pain and comorbid depression have substantially worse disability and health-related quality of life, which persists over long-term follow-up. Diligent efforts to identify and treat depression could potentially improve pain.

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