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    Pain Hinders Depression Treatment

    Chronic Pain, Clinical Depression Both Need Treatment
    By
    WebMD Health News

    Jan. 29, 2004 -- For many people with symptoms of clinical depression, chronic pain can greatly hinder treatment, a new study shows.

    In fact, many people don't get complete relief from antidepressants.

    Upwards of 70% of depressed patients only partially respond to medications; only 30% have a complete resolution of clinical depression, writes researcher Matthew J. Bair, MD, with the Indiana University School of Medicine in Indianapolis.

    His study appears in the January/February issue of Psychosomatic Medicine.

    Further complicating the picture, depressed patients often have multiple overlapping complaints, such as fatigue, insomnia, and pain. At least 60% of the complaints relate to pain, says Bair.

    Very often, patients with chronic pain don't realize they are depressed. If antidepressants are prescribed, they often forget or don't take medication prescribed for it, he says.

    However, it's not been clear whether patients with both clinical depression and chronic pain are any less responsive to antidepressants than patients with depression alone, Blair writes.

    Dual Therapy Needed

    In this study, Bair and his colleagues enrolled 573 patients seen in doctor offices across the U.S. All were diagnosed with clinical depression, a depression severity score was accessed on each patient, and they were randomly assigned to get one of three antidepressants: Prozac, Paxil, or Zoloft.

    Doctors also assessed their chronic body pain and quality of life based on standard checklists.

    The findings:

    • At the study's beginning, two-thirds of the patients -- 69% -- reported some degree of pain.
    • Three months later, slightly fewer -- 58% -- still reported pain. For 33%, the pain was headache pain, which "bothered them a lot."
    • Patients with moderate pain at the study's beginning had twice the odds of a poor response to antidepressants.
    • Patients with severe pain were three to four timesless likely to benefit from antidepressants.

    For patients in pain -- and with clinical depression -- quality of life, like general health measures suffer. "Each incremental increase in pain severity typically doubles the odds of a poor depression treatment response," writes Bair.

    He calls for studies of dual therapy, aimed at treating both the chronic pain and clinical depression.

    SOURCE: Bair, M. Psychosomatic Medicine, January/February 2004; vol 66.

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