Chronic pain common in major depression: large primary care study.(Clinical Rounds)

SAN FRANCISCO -- Fully two-thirds of patients with major depression seen in primary care settings report comorbid chronic pain, Bruce A. Arnow, Ph.D., said at the annual meeting of the American Psychiatric Association.

This "stunning" finding from a large new primary care patient survey underscores the importance of conducting an assessment for chronic pain in patients who are depressed--and for depression in those who present with a complaint involving nonspecific joint pain, headache, or other chronic painful physical conditions, according to Dr. Arnow, chief of outpatient psychiatric clinics at Stanford (Calif.) University.

The findings also raise the intriguing possibility that one reason why achieving remission in major depression often proves elusive is that antidepressants don't typically address the previously underappreciated chronic pain component of the disease, he added.

Dr. Arnow reported on an Eli Lilly-sponsored collaborative study by investigators at Stanford and Kaiser Permanente of Northern California in which 5,808 Kaiser patients participated. All had made a primary care visit within a week before completing a survey that assessed for major depressive disorder and physical symptoms using instruments including the Patient Health Questionnaire, the Short Form-8 for quality-of-life assessment, and the Graded Chronic Pain Scale.

A total of 7.6% of the primary care patients met diagnostic criteria for major depressive disorder as defined by the self-reported presence of at least five of eight symptoms included in the Patient Health Questionnaire.

Criteria for generalized anxiety disorder were met by 6.1% of the sample, panic disorder by 3.6%, and 6.0% of participants were flagged for probable alcohol abuse, he said.

Chronic nondisabling pain lasting at least 6 months was reported by 32.5% of the Kaiser primary care patients, Dr. Arnow said. Another 9.5% reported chronic disabling pain.