Reciprocal relationship between pain and depression: A 12-month longitudinal analysis in primary care

Research output: Contribution to journalArticle

250 Citations (Scopus)

Abstract

Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30 to 50% of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip, or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, P <.0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, P <.0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months. Perspective: This study strengthens the evidence for a bidirectional and potentially causative influence of pain and depression on one another. A change in severity of either symptom predicts subsequent severity of the other symptom. Thus, recognition and management of both conditions may be warranted, particularly when treatment focused on 1 condition is not leading to an optimal response.

Original languageEnglish
Pages (from-to)964-973
Number of pages10
JournalJournal of Pain
Volume12
Issue number9
DOIs
StatePublished - Sep 2011

Fingerprint

compound A 12
Primary Health Care
Depression
Pain
Musculoskeletal Pain
Mood Disorders
Hip
Knee
Clinical Trials
Psychology
Therapeutics

Keywords

  • causation
  • depression
  • longitudinal
  • Pain
  • primary care
  • prognosis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology

Cite this

Reciprocal relationship between pain and depression : A 12-month longitudinal analysis in primary care. / Kroenke, Kurt; Wu, Jingwei; Bair, Matthew J.; Krebs, Erin E.; Damush, Teresa M.; Tu, Wanzhu.

In: Journal of Pain, Vol. 12, No. 9, 01.09.2011, p. 964-973.

Research output: Contribution to journalArticle

@article{34d6aad3ba6b484f85731e4558056db2,
title = "Reciprocal relationship between pain and depression: A 12-month longitudinal analysis in primary care",
abstract = "Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30 to 50{\%} of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip, or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, P <.0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, P <.0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months. Perspective: This study strengthens the evidence for a bidirectional and potentially causative influence of pain and depression on one another. A change in severity of either symptom predicts subsequent severity of the other symptom. Thus, recognition and management of both conditions may be warranted, particularly when treatment focused on 1 condition is not leading to an optimal response.",
keywords = "causation, depression, longitudinal, Pain, primary care, prognosis",
author = "Kurt Kroenke and Jingwei Wu and Bair, {Matthew J.} and Krebs, {Erin E.} and Damush, {Teresa M.} and Wanzhu Tu",
year = "2011",
month = "9",
day = "1",
doi = "10.1016/j.jpain.2011.03.003",
language = "English (US)",
volume = "12",
pages = "964--973",
journal = "Journal of Pain",
issn = "1526-5900",
publisher = "Churchill Livingstone",
number = "9",

}

TY - JOUR

T1 - Reciprocal relationship between pain and depression

T2 - A 12-month longitudinal analysis in primary care

AU - Kroenke, Kurt

AU - Wu, Jingwei

AU - Bair, Matthew J.

AU - Krebs, Erin E.

AU - Damush, Teresa M.

AU - Tu, Wanzhu

PY - 2011/9/1

Y1 - 2011/9/1

N2 - Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30 to 50% of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip, or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, P <.0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, P <.0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months. Perspective: This study strengthens the evidence for a bidirectional and potentially causative influence of pain and depression on one another. A change in severity of either symptom predicts subsequent severity of the other symptom. Thus, recognition and management of both conditions may be warranted, particularly when treatment focused on 1 condition is not leading to an optimal response.

AB - Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30 to 50% of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip, or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, P <.0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, P <.0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months. Perspective: This study strengthens the evidence for a bidirectional and potentially causative influence of pain and depression on one another. A change in severity of either symptom predicts subsequent severity of the other symptom. Thus, recognition and management of both conditions may be warranted, particularly when treatment focused on 1 condition is not leading to an optimal response.

KW - causation

KW - depression

KW - longitudinal

KW - Pain

KW - primary care

KW - prognosis

UR - http://www.scopus.com/inward/record.url?scp=80052270544&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052270544&partnerID=8YFLogxK

U2 - 10.1016/j.jpain.2011.03.003

DO - 10.1016/j.jpain.2011.03.003

M3 - Article

C2 - 21680251

AN - SCOPUS:80052270544

VL - 12

SP - 964

EP - 973

JO - Journal of Pain

JF - Journal of Pain

SN - 1526-5900

IS - 9

ER -