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Pain Med. 2012 Mar;13(3):405-18. doi: 10.1111/j.1526-4637.2011.01322.x. Epub 2012 Feb 7.

Addressing both depression and pain in late life: the methodology of the ADAPT study.

Author information

  • 1Departments of Psychiatry, University of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. karpjf@upmc.edu

Abstract

OBJECTIVE:

To describe the methodology of the first NIH-funded clinical trial for seniors with comorbid depression and chronic low back pain.

METHODS:

Randomized controlled effectiveness trial using stepped care methodology. Participants are ≥60 years old. Phase 1 (6 weeks) is open treatment with venlafaxine xr 150 mg/day and supportive management (SM). Response is 2 weeks of PHQ-9 ≤5 and at least 30% improvement in the average numeric rating scale for pain. Nonresponders progress to phase 2 (14 weeks) in which they are randomized to high-dose venlafaxine xr (up to 300 mg/day) with problem solving therapy for depression and pain (PST-DP) or high-dose venlafaxine xr and continued SM. Primary outcomes are the univariate pain and depression response and both observed and self-reported disability. Survival analytic techniques will be used, and the clinical effect size will be estimated with the number needed to treat. We hypothesize that self-efficacy for pain management will mediate response for subjects randomized to venlafaxine xr and PST-DP.

RESULTS:

Not applicable.

CONCLUSIONS:

The results of this trial will inform the care of these complex patients and further understanding of comorbid pain and depression in late life.

Wiley Periodicals, Inc.

PMID:
22313547
[PubMed - indexed for MEDLINE]
PMCID:
PMC3309151
Free PMC Article
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