Compined pain self-management and antidepressant therapy are effective in patients with chronic musculoskeletal pain with depression.

Question: Does a combination of pain self-management and antidepressant therapy improve pain and depression in people with musculoskeletal pain and depression? Design: Randomised, controlled trial with concealed allocation and blinded outcome assessment. Setting: Six primary care clinics and five tertiary outpatient clinics in the USA. Participants: Primary care patients were eligible if they had at least moderate pain in the low back, hip, or knee, present for at least 3 months despite analgesic medication, and depression of at least moderate severity. People taking antidepressants but who still met the inclusion criteria were eligible. Severe cognitive impairment, major psychoses, and current pain-related disability claims were exclusion criteria. Randomisation of 250 participants allotted 123 to an intervention group and 127 to a control group. Interventions: The intervention group participated in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) program. During the initial 3 months (Step 1), this group optimised their antidepressant medication according to an algorithm based on clinical response, with a potential increased dose at 3 weeks and change of medication at 6 weeks for those who had not improved. During the following 3 months (Step 2), fortnightly pain self-management sessions were conducted by a nurse care manager, modelled on the Combined pain self-management and antidepressant therapy are effective in patients with chronic musculoskeletal pain with depression