Association of Depression and Anxiety Alone and in Combination With Chronic Musculoskeletal Pain in Primary Care Patients

Abstract

OBJECTIVE To assess the relationship between depression and anxiety comorbidity on pain intensity, pain-related disability, and health-related quality of life (HRQL). METHODS Analysis of baseline data from the Stepped Care for Affective disorders and Musculoskeletal Pain (SCAMP) Study. All patients (N = 500) had chronic pain (≥ 3 months duration) of the low back, hip or knee. Patients with depression were over-sampled for the clinical trial component of SCAMP and thus represented 50% of the study population. Patients were categorized according to pain comorbid with depression, anxiety, or both. We used ANOVA and MANOVA models to asess relationships between independent and dependent variables. RESULTS Participants had a mean age of 59 years; were 55% women, 56% white and 40% black. Fifty-four percent (n=271) reported pain only, 20% (n=98) had pain and depression, 3% (n=15) had pain and anxiety, and 23% (n=116) had pain, depression, and anxiety. Patients with pain and both depression and anxiety experienced the greatest pain severity (p < .0001) and pain-related disability (p < .0001). Psychiatric comorbidity was strongly associated with disability days in the past 3 months (p < .0001), with 18.1 days reported by patients with pain only, 32.2 days by those with pain and anxiety, 38.0 days by those with pain and depression, and 42.6 days in those with all three conditions. We found a similar pattern of poorer HRQL (p <.0001) in those with pain, depression, and anxiety. CONCLUSIONS The added morbidity of depression and anxiety with chronic pain is strongly associated with more severe pain, greater disability, and poorer HRQL.

Multidimensional features of pain in patients with chronic neck pain

“…The relevance of these categories for LBP is confirmed by international literature (27,28). Those with chronic pain present mechanical and often-behavioral changes that facilitate the perpetuation of pain due to associated affective difficulties (29). In our study, the main dimension observed was sensory, when compared with the affective dimension seen by Marques et al (26).…”

Comorbidade de sintomas ansiosos e depressivos em pacientes com dor crônica e o impacto sobre a qualidade de vida

“…Chronic pain plays a significant role in incapacitation, making it impossible for individuals to perform physical activities 3 . In addition, this condition is usually comorbid with psychiatric disorders, especially major depression 4,5 . Both conditions are often inadequately treated and result in substantial disability, reduced health-related quality of life (HRQoL) and increased health care costs and utilization 6,7 .…”

Comorbid Chronic Pain and Depression: Patient Perspectives on Empathy

“…Sensitizing concepts (Birks & Mills 2011;Charmaz 2006;Malterud 2001) were established using the focus group guide, in general, the findings of previous studies regarding the SCAMP intervention, and the initial coding results (Bair et al, 2008;Matthias et al, 2010a;Matthias et al, 2010b). Using these codes, the focus group data was analyzed in three phrases.…”

“…The data used for the current study was collected to provide context for and feedback about participants' perspectives on the SCAMP trial (Bair, Wu, Damush, Sutherland, & Kroenke, 2008;Kroenke et al, 2009). After the primary analysis of the focus group data was completed regarding patient perceived barriers and facilitators to selfmanagement of pain was completed, emergent themes were found in deep reviews of the focus group transcripts and warranted further analysis.…”