Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of comorbidity on diagnosis, clinical outcomes, and treatment. The prevalences of pain in depressed cohorts and depression in pain cohorts are higher than when these conditions are individually examined. The presence of pain negatively affects the recognition and treatment of depression. When pain is moderate to severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes (eg, lower quality of life, decreased work function, and increased health care utilization). Similarly, depression in patients with pain is associated with more pain complaints and greater impairment. Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.

Chronic pain is common among those with MDD. Comorbid MDD and disabling chronic pain are associated with greater clinical burden than MDD alone.

Pain is present in two thirds of depressed primary care patients begun on antidepressant therapy, and the severity of pain is a strong predictor of poor depression and health-related quality of life outcomes at 3 months. Better recognition, assessment, and treatment of comorbid pain may enhance outcomes of depression therapy.

• Compare prevalence rates of common comorbid conditions in employees diagnosed as having fibromyalgia (FM) or osteoarthritis (OA).• Identify trends in the use of medical care and prescription drugs by employees having FM or OA, as compared to control subjects.• Contrast total dollar costs and their components-medical costs, drug costs, and indirect costs of time lost from work-in employees with FM, those with OA, and control employees having neither of these disorders. ($10,199) approached OA costs ($10,861, P ϭ 0.3758) Med. 2008;50:13-24)

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This review of DPNP identifies gaps in the literature and highlights the need for further study. The establishment of a consistent definition and diagnostic code for DPNP would improve ability to collect data and understand the impact of DPNP on patients and the health care system. Well-designed, prospective studies are needed to better define the epidemiology and public health burden of DPNP.

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Background Alcohol dependence often goes untreated. Although abstinence is often the aim of alcohol treatment, many drinkers prefer drinking-reduction goals. Therefore, if supported by evidence of benefit, drinking-reduction goals could broaden the appeal of treatment. Regulatory agencies are considering non-abstinent outcomes as clinical trial efficacy indicators, including reduction in the World Health Organization (WHO) drinking risk levels: very high, high, moderate and low, defined in terms of average grams of ethanol per day. Little is known about the relationship between reductions in WHO risk levels and subsequent reduction in the risk for alcohol dependence. Methods In a U.S. national sample, 22 005 drinkers participated in Wave 1 interviews in 2001–2002 and Wave 2 follow-ups 3 years later. Alcohol consumption and alcohol dependence were assessed at both waves. Logistic regression tested the relationship between change in WHO drinking risk levels between Waves 1 and 2, and Wave 2 alcohol dependence. Findings Reductions of 1, 2 or 3 WHO risk levels predicted significantly lower odds of alcohol dependence at Wave 2, particularly among very high and high risk drinkers at Wave 1, and among those with alcohol dependence at Wave 1. Interpretation Results support the use of reductions in WHO drinking risk levels as clinical trial efficacy indicators. Because the levels can readily be translated into average drinks per day using the standard drink equivalents of different countries, the WHO risk levels could also be used internationally to guide treatment goals and clinical recommendations on drinking reduction.