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BackgroundChronic musculoskeletal pain and depression are very common in primary care patients. Furthermore, they often appear as comorbid conditions, resulting in additive effect on adverse health outcomes. On the basis of previous studies, we hypothesise that depression and chronic musculoskeletal pain may benefit from an integrated management programme at primary care level. We expect positive effects on both physical and psychological distress of patients.MethodsObjective: To determine whether a new programme for an integrated approach to chronic musculoskeletal pain and depression leads to better outcomes than usual care.Design: Cluster-randomised controlled trial involving two arms: a) control arm (usual care); and b) intervention arm, where patients participate in a programme for an integrated approach to the pain-depression dyad.Settings: Primary care centres in the province of Tarragona, Catalonia, Spain,Participants: We will recruit 330 patients aged 18–80 with moderate or severe musculoskeletal pain (Brief Pain Inventory, average pain subscale ≥5) for at least 3 months, and with criteria for major depression (DSM-IV).Intervention: A multicomponent programme according to the chronic care model. The main components are care management, optimised antidepressant treatment, and a psychoeducational group action.Blind measurements: The patients will be monitored through blind telephone interviews held at 0, 3, 6 and 12 months.Outcomes: Severity of pain and depressive symptoms, pain and depression treatment response rates, and depression remission rates.Analysis: The outcomes will be analysed on an intent-to-treat basis and the analysis units will be the individual patients. This analysis will consider the effect of the study design on any potential lack of independence between observations made within the same cluster.Ethics: The protocol was approved by the Research Ethics Committee of the Jordi Gol Primary Care Research Institute (IDIAP), Barcelona, (P14/142).DiscussionThis project strengthens and improves treatment approaches for a major comorbidity in primary care. The design of the intervention takes into account its applicability under typical primary care conditions, so that if the programme is found to be effective it will be feasible to apply it in a generalised manner.Trial registrationClinicalTrials.gov: NCT02605278; Registered 28 September, 2015.

Objective The aims of this study were twofold: 1) to better understand the associations between pain-related cognitions and pain severity, and psychological and physical function, and 2) to determine the extent to which these cognitions function as mediators in the association between pain severity and depression in a sample of primary care adult patients with chronic pain and depression. Design Cross-sectional design. Methods Three hundred twenty-eight patients with both depression and chronic pain from primary care centers responded to measures of pain severity, pain interference, depression severity, and pain-related cognitions (including measures of catastrophizing and other pain-related beliefs). We performed three hierarchical regression analyses and two multiple regression analyses. Results The helplessness domain of pain catastrophizing was positively associated with pain severity, depression severity, and pain interference and mediated the relationship between depression and pain severity and vice versa. Beliefs about disability showed a positive association with pain severity, pain interference, and depression severity, and also mediated the relationship between pain severity and depression. Believing in a medical cure was positively associated with pain interference and negatively associated with depression; emotion beliefs were positively associated with pain severity. Conclusions These findings provide important new information about the associations between several pain-related cognitions and pain severity, depression, and pain interference and the potential mediating roles that these cognitions play in the associations between pain severity and depression in patients with both chronic pain and depression in the primary care setting.

Background Chronic pain and depression are frequent comorbidities in primary care. Depression among other psychosocial factors play a role in the clinical course of chronic pain. Objective To study the short and long-term predictive factors of severity and interference of chronic pain in primary care patients with chronic musculoskeletal pain and major depression. Methods Longitudinal study of a cohort of 317 patients. The outcomes are severity and functional interference of pain (Brief Pain Inventory) measured at 3 and 12 months. We performed multivariate linear regression models to estimate the effects the explanatory baseline variables on the outcomes. Results 83% participants were women; average age was 60.3 years (SD = 10.2). In multivariate models, baseline pain severity predicted pain severity at 3 months (β = 0.53; 95% CI = 0.37–0.68) and at 12 months (β = 0.48; 95% CI = 0.29–0.67). Also, pain > 2 years of evolution predicted long term pain severity (β = 0.91; CI95%=0.11–1.71). Baseline pain interference predicted interference at 3 and 12 months (β = 0.27; 95%CI = 0.11–0.43 and β = 0.21; 95%CI = 0.03–0.40, respectively). Baseline pain severity predicted interference at 3 and 12 months (β = 0.26; 95%CI = 0.10–0.42 and β = 0.20; 95%CI = 0.02–0.39, respectively). Pain > 2 years predicted greater severity and greater interference at 12 months (β = 0.91; CI95%=0.11–1.71, and β = 1.23; CI95%=0.41–2.04). Depression severity predicted more interference at 12 months (β = 0.58; CI95%=0.04–1.11). Occupational status as active worker predicted less interference throughout the follow-up (β=-0.74; CI95%=-1.36 to -0.13 and β=-0.96; CI95%=-1.71 to -0.21, at 3 and 12 months). Currently working also predicts less pain severity at 12 months (β=-0.77; CI95%=1.52 − 0.02). With regard to the psychological variables, pain catastrophizing predicted pain severity and interference at three months (β = 0.03; 95% CI = 0.00-0.05 and β = 0.03; 95% CI = 0.00-0.05), but not at long term. Conclusion In a sample of adults with chronic pain and depression, this primary care study has identified prognostic factors that independently predict the severity and functional interference of pain. If confirmed in new studies, these factors should be targeted for individualized interventions. Trial registration ClinicalTrials.gov (NCT02605278), registered 16/11/2015.

Background: Chronic pain and depression are frequent comorbidities in primary care. Depression and other clinical, psychological and social factors influence the clinical course of chronic pain.Objective: To study the short and long-term predictive factors of severity and interference of chronic pain in primary care patients with chronic musculoskeletal pain and major depression.Methods: Longitudinal study of a cohort of 328 patients. The outcomes are severity and functional interference of pain (Brief Pain Inventory) measured at 3 and 12 months.Results: 83% participants were women; average age was 60.3 years (SD=10.2). In multivariate models, baseline pain intensity predicted pain intensity at 3 months (β= 0.48; 95% CI=0.30-0.67) and at 12 months (β=0.39; 95% CI=0.17-0.61). Also, pain >2 years of evolution predicted long term pain intensity (β=0.86; CI95%=0.05-1.66). Occupational status as active worker predicted lower intensity at 12 months (β=-0.78; CI95%=-1.53 ​​to -0.03). Baseline pain interference predicted interference at 3 and 12 months (β=0.25; 95%CI=0.09-0.41 and β=0.22; 95%CI=0.02-0.41, respectively). Pain >2 years predicted greater interference at 12 months (β=1.07; CI95%=0.24-1.89). Physical comorbidity (Duke Severity of Illness score) was associated with greater interference in the short term (β=0.02; CI95 %= 0.00-2.05). Occupational status as active worker predicted less interference throughout the follow-up (β=-0.72; CI95%=-1.34 to -0.11 and β=-0.95; CI95%=-1.70 to -0.21, at 3 and 12 months).With regard to the psychological variables, catastrophism (Pain Catastrophizing Scale) predicted greater pain intensity and interference at three months (β=0.35; 95% CI=0.03-0.68 and β=0.36; 95% CI =0.02-0.71), but not long term.Conclusion: In a sample of adults with chronic pain and depression, this primary care study has identified various prognostic factors that independently predict the intensity and functional interference of pain. These factors should be targeted for individualized interventions. Trial registration: ClinicalTrials.gov (NCT02605278), registered 16/11/2015.

Background The COVID-19 pandemic has constituted an extraordinarily stressful situation for healthcare professionals and has led to psychological distress and an increase in various mental disorders. In the post-pandemic context, it is necessary to provide professionals with strategies and skills to manage this stressful situation and prevent or minimize its negative impact. Methods Aims: To assess the feasibility and clinical effects of a group psychoeducational program focused on preventing the adverse psychological and emotional effects of the pandemic on primary care workers, and to explore the experience and perceptions of participants with regard to the program from a qualitative perspective. Design: A single-arm, before-and-after study conducted in primary care. Setting: The 332 primary care centers of the Catalan Institute of Health (Catalonia) Participants: The target population of the intervention is primary care workers of all professional profiles. The implementation strategy will also involve community psychologists, who will lead the psychoeducational groups, and the health organization promoting the implementation. Intervention: A group psychoeducational program targeting primary care workers to promote emotional well-being and the ability to cope with stressful situations. Community psychologists will deliver it in the primary care centers they are linked to. Measures: Mixed-methods evaluation, analyzing quantitative and qualitative data. A prospective assessment of the main outcomes (professional quality of life, psychological state, and resilience) will be performed using online questionnaires before and immediately after the intervention, and at 3 and 6 months. A qualitative study will be conducted, comprising focus groups and individual in-depth interviews with the participants in the intervention and the psychologists who provide it. Ethics: The Research Ethics Committee of the Jordi Gol Primary Care Research Institute (IDIAP) has approved the protocol (22/086-PCV). Discussion This project proposes an intervention to promote mental health and psychological well-being in primary care workers by learning skills and integrating them into personal and professional life. The expected results will allow us to determine the usefulness and effectiveness of this psychoeducational intervention under the conditions of real clinical practice, provide data to model and perfect it, and promote its dissemination. Trial registration ClinicalTrials.gov Identifier: NCT05720429.