Stage of chronicity and treatment response in patients with musculoskeletal injuries and concurrent symptoms of depression ☆
- 1 March 2008
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Pain
- Vol. 135 (1), 151-159
- https://doi.org/10.1016/j.pain.2007.05.021
Abstract
The present study examined the relation between stage of chronicity and treatment response in patients with work-related musculoskeletal conditions and concurrent depressive symptoms. Also of interest was the role of reductions in pain severity, catastrophic thinking and fear of movement/re-injury as mediators of the relation between chronicity and treatment response. A sample of 80 individuals (38 women, 42 men) with a disabling musculoskeletal pain condition and concurrent depressive symptoms participated in the research. Individuals with work absence of less than 6 months (range 12–26 weeks) were classified as early chronic (N = 40), and individuals with work absence greater than 6 months (range 27–52 weeks) were classified as chronic. Both groups were matched on sex, age (±2 years) and severity of depressive symptoms. All participants were enrolled in a 10-week community-based disability management intervention. The early chronic group showed significantly greater reduction in depressive symptoms, and pain symptoms, than the chronic group. Regression analyses revealed that pain reduction, but not catastrophic thinking or fear of movement/re-injury, mediated the relation between chronicity and improvement in depressive symptoms. The results highlight the importance of early detection and treatment of depressive symptoms, given that treatment response decreases over time. The results also suggest that reductions in depressive symptoms might be a precondition to the effective reduction of pain symptoms in this population. Discussion addresses the factors that might contribute to treatment resistance as the period of disability extends over time.Keywords
This publication has 35 references indexed in Scilit:
- The importance of symptom duration in determining prognosisPain, 2006
- Duloxetine in the acute and long-term treatment of major depressive disorder: a placebo- and paroxetine-controlled trialEuropean Neuropsychopharmacology, 2004
- Persistent pain and depression: a biopsychosocial perspectiveBiological Psychiatry, 2003
- Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis.Journal of Consulting and Clinical Psychology, 2003
- Psychological Correlates of Opioid Use in Patients with Chronic Nonmalignant Pain: A Preliminary Test of the Downhill Spiral HypothesisJournal of Pain and Symptom Management, 2000
- Health and Disability Costs of Depressive Illness in a Major U.S. CorporationAmerican Journal of Psychiatry, 2000
- Negative Affect, Self-Report of Depressive Symptoms, and Clinical Depression: Relation to the Experience of Chronic PainThe Clinical Journal of Pain, 2000
- Disability Resulting From Occupational Low Back PainSpine, 1996
- Explaining high rates of depression in chronic pain: A diathesis-stress framework.Psychological Bulletin, 1996
- The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology, 1986