Pain complicates depression treatment in elderly

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 Thursday, March 8, 2007

By Michelle Rizzo

NEW YORK (Reuters Health) - By interfering with normal activities, chronic pain can impede recovery from depression in older adults, according to findings reported in the Journal of the American Geriatrics Society.

Dr. Shahrzad Mavandadi, of the University of Pennsylvania, Philadelphia, and colleagues examined the effects of pain on the response to depression treatment in 524 men, 60 years of age or older, who were seen at a VA medical center.

The men were randomly assigned to an integrated care group, in which patients saw a mental health professional at a primary care clinic, or to a specialty care group, in which the patient was referred to a mental health professional at another facility.

The researchers assessed the patients' pain severity, the degree to which pain interfered with work inside and outside the home, and depression symptoms at the beginning of the study and at 3, 6, and 12 months.

The results showed that depression symptoms decreased over time in both treatment groups. However, pain modified the reductions in symptoms.

Patients who reported higher levels of pain severity and more interference with work activity had less improvement in their depression symptoms. Pain that interfered with activities had a greater effect on depression symptoms, than did pain severity, the team reports.

These findings, and the fact that pain and depression often occur together in the elderly, suggest that older patients who are being treated for depression might benefit from routine assessment of pain as well as any other medical conditions that may complicate their treatment, Mavandadi said in an interview with Reuters Health.

"Better assessment and treatment of these conditions may improve depression...outcomes," she said. Also, when patients with pain are being assessed to confirm a depression diagnosis and determine the course of treatment, it may help to incorporation tests that address various aspects of the pain condition, rather than just pain severity.

Mavandadi also noted that these findings may be attributed to a number of factors. For example, she suggested that the mere experience of pain may contribute to greater distress and depressive symptoms both directly and indirectly through its impact on physical and psychosocial functioning.

Pain can also interfere with "the patients' and providers' ability to manage depression," Mavandadi said. "Dealing with severe pain may be distracting and hinder, both physically and psychologically, the patient's ability to concentrate on a treatment regimen or successfully engage in treatment visits," she explained. Furthermore, pain and depression each require time and attention.

SOURCE: Journal of the American Geriatrics Society, February 2007.

Date last updated: 09 March 2007