CoChat
Sign Up
Cited by 447Musculoskeletal pain and rehabilitationTreatment of Major DepressionPain Management and Opioid Use

Optimized Antidepressant Therapy and Pain Self-management in Primary Care Patients With Depression and Musculoskeletal Pain: A Randomized Controlled Trial

Open access
Kroenke, Kurt, Bair, Matthew J., Damush, Teresa M., Wu, Jingwei, Hoke, Shawn, Sutherland, Jason, Tu, Wanzhu·2009·JAMA
DOI 10.1001/jama.2009.723PMC PMC2884224
Open this paper in CoChat — free account

Abstract

CONTEXT: Pain and depression are the most common physical and psychological symptoms in primary care, respectively. Moreover, they co-occur 30% to 50% of the time and have adverse effects on quality of life, disability, and health care costs. OBJECTIVE: To determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and comorbid depression. DESIGN, SETTING, AND PATIENTS: Randomized controlled trial (Stepped Care for Affective Disorders and Musculoskeletal Pain [SCAMP]) conducted at 6 community-based clinics and 5 Veterans Affairs general medicine clinics in Indianapolis, Indiana. Recruitment occurred from January 2005 to June 2007 and follow-up concluded in June 2008. The 250 patients had low back, hip, or knee pain for 3 months or longer and at least moderate depression severity (Patient Health Questionnaire 9 score > or = 10). INTERVENTION: Patients were randomly assigned to the intervention (n = 123) or to usual care (n = 127). The intervention consisted of 12 weeks of optimized antidepressant therapy (step 1) followed by 6 sessions of a pain self-management program over 12 weeks (step 2), and a continuation phase of therapy for 6 months (step 3). MAIN OUTCOME MEASURES: Depression (20-item Hopkins Symptom Checklist), pain severity and interference (Brief Pain Inventory), and global improvement in pain at 12 months. RESULTS: At 12 months, 46 of the 123 intervention patients (37.4%) had a 50% or greater reduction in depression severity from baseline compared with 21 of 127 usual care patients (16.5%) (relative risk [RR], 2.3; 95% confidence interval [CI], 1.5-3.2), corresponding to a much lower number of patients with major depression (50 [40.7%] vs 87 [68.5%], respectively; RR, 0.6 [95% CI, 0.4-0.8]). Also, a clinically significant (> or = 30%) reduction in pain was much more likely in intervention patients (51 intervention patients [41.5%] vs 22 usual care patients [17.3%]; RR, 2.4 [95% CI, 1.6-3.2]), as was global improvement in pain (58 [47.2%] vs 16 [12.6%], respectively; RR, 3.7 [95% CI, 2.3-6.1]). More intervention patients also experienced benefits in terms of the primary outcome, which was a combined improvement in both depression and pain (32 intervention patients [26.0%] vs 10 usual care patients [7.9%]; RR, 3.3 [95% CI, 1.8-5.4]). CONCLUSION: Optimized antidepressant therapy followed by a pain self-management program resulted in substantial improvement in depression as well as moderate reductions in pain severity and disability. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00118430.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jama.2009.723

Cites

81 of 81 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Collaborative interdisciplinary care improves management of depression, anxiety, pain, and substance abuse in primary care.

    “Several studies demonstrate that collaborative interdisciplinary care improves management of depression, anxiety, pain, and substance abuse in primary care. 14-18”

    From Decision Support and Behavioral Health for Reducing High-Dose Opioids in Comorbid Chronic Pain, Depression and Anxiety: Stepped-Wedge Cluster Randomized Trial (2024) · cites this paper as [17]

    The Methods describe a nurse care manager supervised by a physician depression specialist, and the Results report improved depression and pain outcomes in primary care patients, with less severe anxiety as a secondary outcome (pages unavailable in our copy). The paper does not report improved management of substance abuse, so it does not support the full list of conditions attributed to it. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

1 retracted

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Kroenke, K., Bair, M. J., Damush, T. M., Wu, J., Hoke, S., Sutherland, J., & Tu, W.
Affiliations
  • Indiana University Indianapolis (US)
  • Dartmouth Institute for Health Policy and Clinical Practice (US)
  • Dartmouth College (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2009-05-27
Volume
301
Issue
20
Pages
2099
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2009.723
PMC
PMC2884224
OpenAlex
W2084739652
Cited by
447
References
81
Citations by year
2026: 13 · 2025: 14 · 2024: 22 · 2023: 13 · 2022: 19 · 2021: 17 · 2020: 26 · 2019: 28 · 2018: 38 · 2017: 25 · 2016: 26 · 2015: 23 · 2014: 27 · 2013: 35 · 2012: 42
FWCI
28.99
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
National Institute of Mental Health (R01MH071268)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
depression, musculoskeletal pain, antidepressant treatment, pain self-management, stepped care, major depressive disorder, low back pain, hip pain, knee pain, pain intensity, pain interference, veterans, primary care, behavioral interventions, relapse prevention, relapse prevention training
MeSH terms
Adult, Aged, Antidepressive Agents, Chronic Disease, Major Depressive Disorder, Female, Hip Joint, Humans, Knee Joint, Male, Middle Aged, Pain, Pain Measurement, Primary Health Care, Psychiatric Status Rating Scales, Self Care, Comorbidity, Cognitive Behavioral Therapy, Low Back Pain, Pain Management

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review