Depression Responds to Collaborative Care

April 17, 2009

Persons with chronic pain who participated in a collaborative care program with primary care physicians and psychologists showed improvement in depression, pain severity, and pain-related disability compared with those who received treatment by primary care physicians only, according to a study published in the March 25 issue of the Journal of the American Medical Association.

Persons with chronic pain who participated in a collaborative care program with primary care physicians and psychologists showed improvement in depression, pain severity, and pain-related disability compared with those who received treatment by primary care physicians only, according to a study published in the March 25 issue of the Journal of the American Medical Association.

Steven K. Dobscha, MD, of the Portland Veterans Affairs Medical Center, Ore, and colleagues assessed whether a collaborative care intervention would improve chronic pain– related outcomes, including depression, compared with treatment as usual among 401 patients treated at 5 primary care clinics. The researchers found that patients with baseline depression (Patient Health Questionnaire 9 [PHQ-9] score equal to or more than 10) and who received intervention treatment showed significantly greater improvement in depression severity than those who received treatment as usual (PHQ-9 , 20.177 [95% confidence interval, 20.295 to 0.060]; P = .003).

Compared with treatment-as-usual patients during 12 months, intervention patients showed significantly greater improvements in pain-related disability and pain intensity than treatment-as-usual patients during that period. At 12 months, 21.9% of intervention patients versus 14% of treatment-as-usual patients demonstrated 30% reductions in a measure of pain-related disability.

The researchers randomized 42 primary care physicians to the pain-treatment intervention group or the treatment-as-usual group. The patients had received diagnoses of musculoskeletal pain, had moderate or greater pain intensity, and had disability lasting 12 weeks or longer and were assigned to the same treatment groups as their physicians. Assistance with pain treatment included a 2-session clinician education program, patient assessment, symptom monitoring, feedback, and recommendations to clinicians and facilitation of specialty care. Primary care physicians also received support from a psychologist care manager and an internist, both of whom received special training as part of the program but had no previous extensive education in pain management.

The intervention included a 4-session workshop for patients, and the psychologist telephoned patients every 2 months to evaluate them for depression, pain control, and substance use disorder. Patients and clinicians assigned to usual care had access to the hospital’s specialty pain clinic and such ancillary ser-vices as occupational and physical therapy and behavioral health treatment.

“A collaborative, primary care–based intervention can have positive effects on pain disability and intensity, and on depressive symptoms,” the authors concluded. ?