Rebecca L. Robinson

Comorbid depression, chronic pain, and disability in primary care.

Objectives: The objectives of this study were to provide estimates of the prevalence and strength of association between major depression and chronic pain in a primary care population and to examine the clinical burden associated with the two conditions, singly and together. Methods: A random sample of Kaiser Permanente patients who visited a primary care clinic was mailed a questionnaire assessing major depressive disorder (MDD), chronic pain, pain-related disability, somatic symptom severity, panic disorder, other anxiety, probable alcohol abuse, and health-related quality of life (HRQL). Instruments included the Patient Health Questionnaire, SF-8, and Graded Chronic Pain Questionnaire. A total of 5808 patients responded (54% of those eligible to participate). Results: Among those with MDD, a significantly higher proportion reported chronic (i.e., nondisabling or disabling) pain than those without MDD (66% versus 43%, respectively). Disabling chronic pain was present in 41% of those with MDD versus 10% of those without MDD. Respondents with comorbid depression and disabling chronic pain had significantly poorer HRQL, greater somatic symptom severity, and higher prevalence of panic disorder than other respondents. The prevalence of probable alcohol abuse/dependence was significantly higher among persons with MDD compared with individuals without MDD regardless of pain or disability level. Compared with participants without MDD, the prevalence of other anxiety among those with MDD was more than sixfold greater regardless of pain or disability level. Conclusions: Chronic pain is common among those with MDD. Comorbid MDD and disabling chronic pain are associated with greater clinical burden than MDD alone. MDD = major depressive disorder; HRQL = health-related quality of life; HMO = health maintenance organization; PHQ = Patient Health Questionnaire; GCPS = Graded Chronic Pain Scale; CP = chronic pain; DCP = disabling chronic pain; GAD = generalized anxiety disorder; SCID = Structured Clinical Interview for DSM-III-R; PRIME-MD = Primary Care Evaluation of Mental Disorders; CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; DSM-III-R = Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised.

Impact of Pain on Depression Treatment Response in Primary Care

Objective Pain commonly coexists with depression, but its impact on treatment outcomes has not been well studied. Therefore, we prospectively evaluated the impact of comorbid pain on depression treatment response and health-related quality of life. Methods We analyzed data from the ARTIST study, a randomized controlled trial with naturalistic follow-up conducted in 37 primary care clinics. Participants were 573 clinically depressed patients randomized to one of three selective serotonin reuptake inhibitor (SSRI) antidepressants: fluoxetine, paroxetine, or sertraline. Depression as assessed by the Symptom Checklist-20 (SCL-20) was the primary outcome. Secondary outcomes included pain and health-related quality of life. Results Pain was reported by more than two thirds of depressed patients at baseline, with the severity of pain mild in 25% of patients, moderate in 30%, and severe in 14%. After 3 months of antidepressant therapy, 24% of patients had a poor depression treatment response (ie, SCL-20 >1.3). Multivariate odds ratios for poor treatment response were 1.5 (95% confidence interval, 0.8–3.2) for mild pain, 2.0 (1.1–4.0) for moderate pain, and 4.1 (1.9–8.8) for severe pain compared with those without pain. Increasing pain severity also had an adverse impact on outcomes in multiple domains of health-related quality of life. Conclusions 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.

Employees With Fibromyalgia : Medical Comorbidity, Healthcare Costs, and Work Loss

Objectives: To compare 2005 health care resources among matched samples of employees with fibromyalgia (FM), osteoarthritis (OA), and controls. Methods: Using a claims database of privately insured individuals, FM and OA samples were derived from those with two or more disease-specific claims in 1999 to 2005 (≥1 in 2002 to 2005). Results: Total costs for employees with FM (

PREMENSTRUAL SYMPTOM SEVERITY: IMPACT ON SOCIAL FUNCTIONING AND TREATMENT SEEKING BEHAVIORS

10,199) approached OA costs (

Catastrophizing, depression and pain-related disability.

10,861, P = 0.3758) and were significantly higher than controls (

Incidence and impact of pain conditions and comorbid illnesses

5274, P < 0.0001). Cost components varied across disease-specific samples (direct medical: FM

In search of pharmacoeconomic evaluations for fibromyalgia treatments: a review.

7286 vs OA

Comparison of Health Care Use and Costs in Newly Diagnosed and Established Patients With Fibromyalgia

8325, P < 0.0287; pharmacy: FM

Long-term evaluation of opioid treatment in fibromyalgia

1630 vs OA

Burden of illness and treatment patterns for patients with fibromyalgia.

1341; indirect: FM