Combo Treatment Relieves Comorbid Pain and Depression

A two-pronged intervention of optimized antidepressant and behavioral pain management therapy improves symptoms of comorbid pain and depression, a randomized trial showed.

The intervention yielded a clinically and statistically significant reduction of at least 50% in depression symptoms and at least 30% in pain for three times more patients than did usual care, which was significant at both six months (23.6% versus 7.9%) and 12 months (26.0% versus 7.9%).

The number needed to treat to improve pain to this threshold was 4.1, and it was 4.8 to achieve a response for depression, Kurt Kroenke, M.D., of Indiana University in Indianapolis, and colleagues reported in the May 27 issue of the Journal of the American Medical Association.

This was similar to the number needed to treat of 4 in a Cochrane review of antidepressants compared with placebo or no treatment in medically ill adults, they noted.

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Indications for Antidepressant use in patients with chronic pain disorders

....USE OF ANTIDEPRESSANTS IN THE MANAGEMENT OF CHRONIC PAIN
Pain and depression are closely intertwined, strongly hinting at a shared neurophysiology. As a consequence, one prevailing pharmacologic strategy identifies a central role for serotonin and norepinephrine reuptake inhibitors (SNRIs).1 Other justifications, even without a common biologic rationale, strongly support the use of antidepressants in the management of chronic pain. For example, chronic pain characteristically causes sleep problems, anxiety, and depression, all of which may improve with antidepressant treatment.2 Providing an effective, nonhabituating sleep medication that also improves mood may significantly enhance the patient’s quality of life....

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