Community programme reduces depression in patients with chronic pain, study showsBMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i3352 (Published 16 June 2016) Cite this as: BMJ 2016;353:i3352
A community based programme helping patients to use a cognitive behavioural approach to manage chronic pain reduced depression but not pain related disability over 12 months, a UK study has shown.1
Researchers randomly assigned 703 adults (mean age 59.9) with musculoskeletal pain for more than three months to a group intervention or to usual care plus a relaxation CD. The group intervention involved sessions for learning cognitive behavioural approaches, with a follow-up session at two weeks. The aim was to help people self manage their chronic pain.
Study participants were recruited from 27 general practices and community musculoskeletal services across the United Kingdom. Most (85%) had had chronic pain for at least three years, and nearly one in four had a prescription for strong opioids.
“Chronic musculoskeletal pain is the leading cause of disability worldwide,” said the researchers, led by Steph Taylor, of Queen Mary University of London. They noted that the effectiveness of drug treatments for chronic pain is often limited and that concern is growing about potential adverse effects, including opioid dependence.
The results, published in PLoS Medicine, showed no significant difference between people attending group sessions and the control participants in pain related disability at six or 12 months (–1 on the Chronic Pain Grade disability subscale (95% confidence interval –4.9 to 3.0)), pain intensity, or general health as measured in the 2011 census.
But depression significantly improved in patients attending group sessions (–0.7 on the Hospital Anxiety and Depression Scale (–4.9 to 3.0)), and social integration also improved (0.8 on the Health Education Impact Questionnaire social integration and support subscale (0.4 to 1.2)).
Taylor said, “The study holds out the tantalising prospect that the new intervention could improve the psychological wellbeing of patients with chronic musculoskeletal pain,” but she added, “Further research is needed before this conclusion can be firmly drawn.” The team noted that the intervention was relatively brief and did not involve physical activity.
A cost-utility analysis showed a small benefit in quality adjusted life years (0.325 (–0.0074 to 0.0724)), and the intervention was slightly more expensive than usual care (£188 (€237; $265)). The incremental cost effectiveness ratio was £5786 per QALY.