Impact of pain on depression treatment response in primary care
Abstract
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.
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When self-report measures of depression are used, the prevalence of depression in individuals experiencing chronic pain is as high as 86%.
“When self-report measures of depression are used, the prevalence of depression in individuals experiencing chronic pain is as high as 86%”
From From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. (2014) · cites this paper as Bair et al., 2004
Previous studies show that older age is associated with increased pain severity.
“These latter fi ndings are consistent with previous studies that older age is associated with increased pain severity (Bair et al., 2004; Demyttenaere et al., 2006).”
From Presence and predictors of pain in depression: Results from the FINDER study (2010) · cites this paper as Bair et al., 2004
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- Authors
- Bair, M. J., Robinson, R. L., Eckert, G. J., Stang, P. E., Croghan, T. W., & Kroenke, K.
- Affiliations
- Regenstrief Institute (US)
- University of North Carolina at Chapel Hill (US)
- Venue
- Psychosomatic Medicine
- Published
- 2004-01
- Volume
- 66
- Issue
- 1
- Pages
- 17-22
- ISSN
- 0033-3174 (ISSN-L)
- OpenAlex
- W2080747491
- Cited by
- 371
- References
- 42
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 16 · 2023: 9 · 2022: 15 · 2021: 17 · 2020: 6 · 2019: 8 · 2018: 12 · 2017: 14 · 2016: 17 · 2015: 20 · 2014: 25 · 2013: 29 · 2012: 22
- FWCI
- 10.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- pain, depression, comorbidities, antidepressant response, selective serotonin reuptake inhibitors, fluoxetine, paroxetine, sertraline, health-related quality of life, pain intensity, primary care, artist study
- MeSH terms
- Adult, Antidepressive Agents, Depressive Disorder, Female, Fluoxetine, Follow-Up Studies, Humans, Male, Middle Aged, Pain, Pain Measurement, Quality of Life, Treatment Failure, Selective Serotonin Reuptake Inhibitors, Paroxetine, Sertraline
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