OBJECTIVE: The combination of chronic musculoskeletal pain and depression is associated with worse clinical outcomes than either condition alone. In this study, we report the predictors of pain intensity and activity interference in primary care patients with co-morbid pain and depression. METHODS: This is a secondary data analysis of the 250 persons who participated in a randomized clinical trial designed to test the effectiveness of 12 weeks of optimized antidepressant therapy for both depression and pain. Using multivariate linear regression analysis, we assessed the predictive value of baseline self-efficacy, fear of movement, pain beliefs, and demographic and clinical factors on 3-month Graded Chronic Pain Scale pain intensity and activity interference outcomes. RESULTS: In the full model, significant sociodemographic predictors of less activity interference included being non-white (beta-5.8, P = 0.04) and being employed (beta-13.3, P < 0.0001). The latter was also predictive of less pain intensity (beta-5.6, P = 0.01). As expected, the optimized antidepressant treatment arm was associated with improved outcomes (pain intensity: beta-3.7, P = 0.0005 and activity interference: beta-6.4, P = 0.01). Whereas stronger perceived pain control (beta 3.6, P = 0.01) was associated with greater activity interference, higher degree of fear of movement (or fear avoidance) predicted greater pain intensity (beta 0.46, P = 0.04) and activity interference (beta 0.57, P = 0.05). Neither the location (low back vs hip/knee) nor duration of pain were predictive of pain intensity or interference outcomes. CONCLUSION: The findings are consistent with a bio-psychosocial model, implicating the need to consider the impact of sociodemographic variables and pain-related beliefs and cognition on pain-related outcomes for patients with co-morbid musculoskeletal pain and depression.
RCT Entities:
OBJECTIVE: The combination of chronic musculoskeletal pain and depression is associated with worse clinical outcomes than either condition alone. In this study, we report the predictors of pain intensity and activity interference in primary care patients with co-morbid pain and depression. METHODS: This is a secondary data analysis of the 250 persons who participated in a randomized clinical trial designed to test the effectiveness of 12 weeks of optimized antidepressant therapy for both depression and pain. Using multivariate linear regression analysis, we assessed the predictive value of baseline self-efficacy, fear of movement, pain beliefs, and demographic and clinical factors on 3-month Graded Chronic Pain Scale pain intensity and activity interference outcomes. RESULTS: In the full model, significant sociodemographic predictors of less activity interference included being non-white (beta-5.8, P = 0.04) and being employed (beta-13.3, P < 0.0001). The latter was also predictive of less pain intensity (beta-5.6, P = 0.01). As expected, the optimized antidepressant treatment arm was associated with improved outcomes (pain intensity: beta-3.7, P = 0.0005 and activity interference: beta-6.4, P = 0.01). Whereas stronger perceived pain control (beta 3.6, P = 0.01) was associated with greater activity interference, higher degree of fear of movement (or fear avoidance) predicted greater pain intensity (beta 0.46, P = 0.04) and activity interference (beta 0.57, P = 0.05). Neither the location (low back vs hip/knee) nor duration of pain were predictive of pain intensity or interference outcomes. CONCLUSION: The findings are consistent with a bio-psychosocial model, implicating the need to consider the impact of sociodemographic variables and pain-related beliefs and cognition on pain-related outcomes for patients with co-morbid musculoskeletal pain and depression.
Authors: Edit Vereckei; Vereckei Edit; Eva Susanszky; Susanszky Eva; Maria Kopp; Kopp Maria; Istvan Ratko; Ratko Istvan; Agnes Czimbalmos; Czimbalmos Agnes; Zsolt Nagy; Nagy Zsolt; Eva Palkonyai; Palkonyai Eva; Laszlo Hodinka; Hodinka Laszlo; Peter I Temesvari; Temesvari I Peter; Emese Kiss; Kiss Emese; Klara Töro; Töro Klara; Gyula Poor; Poor Gyula Journal: Rheumatol Int Date: 2012-04-03 Impact factor: 2.631
Authors: Steven K Dobscha; Benjamin J Morasco; Anne E Kovas; Dawn M Peters; Kyle Hart; Bentson H McFarland Journal: Pain Med Date: 2014-12-28 Impact factor: 3.750
Authors: Ann M Taylor; Kristine Phillips; Kushang V Patel; Dennis C Turk; Robert H Dworkin; Dorcas Beaton; Daniel J Clauw; Monique A M Gignac; John D Markman; David A Williams; Shay Bujanover; Laurie B Burke; Daniel B Carr; Ernest H Choy; Philip G Conaghan; Penney Cowan; John T Farrar; Roy Freeman; Jennifer Gewandter; Ian Gilron; Veeraindar Goli; Tony D Gover; J David Haddox; Robert D Kerns; Ernest A Kopecky; David A Lee; Richard Malamut; Philip Mease; Bob A Rappaport; Lee S Simon; Jasvinder A Singh; Shannon M Smith; Vibeke Strand; Peter Tugwell; Gertrude F Vanhove; Christin Veasley; Gary A Walco; Ajay D Wasan; James Witter Journal: Pain Date: 2016-09 Impact factor: 7.926
Authors: Eric W de Heer; Jack Dekker; Jonna F van Eck van der Sluijs; Aartjan Tf Beekman; Harm Wj van Marwijk; Tjalling J Holwerda; Pierre M Bet; Joost Roth; Leona Hakkaart-Van Roijen; Lianne Ringoir; Fiona Kat; Christina M van der Feltz-Cornelis Journal: BMC Psychiatry Date: 2013-05-24 Impact factor: 3.630