Effectiveness of a collaborative care intervention for managing major depression and chronic musculoskeletal pain in primary care: A cluster-randomised controlled trial
Abstract
Background Depression and chronic musculoskeletal pain commonly occur as comorbid conditions, which increases their negative effects on health outcomes. The objective of this study was to assess the effectiveness of the DROP (DepRessiOn and Pain) programme designed for the management of major depression and chronic musculoskeletal pain in primary care.Methods A cluster-randomised controlled trial was carried out between June 2015 and December 2017 with 328 patients with major depression and chronic musculoskeletal pain, randomly allocated to either intervention arm or usual care arm. The intervention included care management, optimised management of depression, and a psychoeducational programme. Outcomes were monitored using blinded interviews over a 12-month period.Trial registration NCT02605278 (ClinicalTrials.gov).Results After 12 months, 274 patients were evaluated (83.5% participation). The severity of depression (Hopkins Symptom Checklist score) was 0.23 points lower in the intervention arm [1.11 vs. 1.34; CI95% = -0.42 to -0.04]. Intervention arm's response rate to antidepressant treatment was 18.9% higher [39.6% vs. 20.7%; OR = 2.74; CI95% = 1.12-6.67] and its remission rate for depression was 9.0% higher [20.1% vs. 11.1%; OR = 2.13; CI95% = 0.94-4.85] compared to the usual care arm. There were no significant differences between the two arms in terms of pain severity (Brief Pain Inventory severity score) [6.23 vs. 6.66; difference = -0.39; CI95% = -1.13-0.35] or pain response rate [18.7% vs. 18.5%; OR = 1.02; CI95% = 0.46-2.26].Limitations This is a pragmatic study, and poor adherence to the programme by patients and physicians was a main limitation.Conclusion The programme improves clinical outcomes for depression, although no clinical benefits were seen for pain.
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No significant differences in the reduction of pain interference at follow-up were found in the two studies that explored this outcome in favor of CBT compared to treatment as usual.
“but not at the follow-up in the two studies (0%) that explored this outcome (Buhrman et al., 2015; Aragonès et al., 2019), in favor of the CBT compared to TAU.”
From A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress (2023) · cites this paper as Aragonès et al., 2019
In Aragonès et al. (2019), there was no significant between-group difference at any timepoints on pain severity, pain interference and pain response rates.
“No significant between-group difference at any timepoints on pain severity, pain interference and pain response rates”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as Aragonès et al, (2019)
In Aragonès et al. (2019), the severity of depression decreased in both groups over the follow-up period.
“The severity of depression decreased in both groups over the follow-up period.”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as Aragonès et al, (2019)
In Aragonès et al. (2019), better results at 12 months were found in the DROP group than the usual care group with a between-group difference of -.23 (d = .32, 95% CI .08, .56, P = .02).
“Better results at 12 months in the DROP group than the usual care group with a between-group difference of -.23 (d = .32, 95% CI .08, .56, P = .02)”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as Aragonès et al, (2019)
Another 4 large trials included an intervention with multiple components.
“Another 4 large trials included an intervention with multiple components. 37-40”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [37]
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- Authors
- Aragonès, E., Rambla, C., López-Cortacans, G., Tomé-Pires, C., Sánchez-Rodríguez, E., Caballero, A., & Miró, J.
- Affiliations
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (ES)
- Institut de Recerca Biomèdica Catalunya Sud (ES)
- Corresponding author
- Aragonès, Enric
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 252
- Pages
- 221-229
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2939212511
- Cited by
- 50
- References
- 47
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 9 · 2023: 17 · 2022: 6 · 2021: 6 · 2020: 4
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Instituto de Salud Carlos III
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- major depressive disorder, chronic musculoskeletal pain, pain-depression comorbidity, collaborative care, primary care, care management, psychoeducation, antidepressant response, depression remission, pain intensity
- MeSH terms
- Intersectoral Collaboration, Adult, Antidepressive Agents, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Patient Education as Topic, Primary Health Care, Program Evaluation, Cluster Analysis, Treatment Outcome, Chronic Pain, Musculoskeletal Pain
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