Bair Matthew J, Robinson Rebecca L, Eckert George J, Stang Paul E, Croghan Thomas W, Kroenke Kurt
Regenstrief Institute and the Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Psychosom Med. 2004 Jan-Feb;66(1):17-22. doi: 10.1097/01.psy.0000106883.94059.c5.
Pain commonly coexists with depression, but its impact on treatment outcomes has not been well studied. Therefore, we prospectively evaluated the impact of comorbid pain on depression treatment response and health-related quality of life.
We analyzed data from the ARTIST study, a randomized controlled trial with naturalistic follow-up conducted in 37 primary care clinics. Participants were 573 clinically depressed patients randomized to one of three selective serotonin reuptake inhibitor (SSRI) antidepressants: fluoxetine, paroxetine, or sertraline. Depression as assessed by the Symptom Checklist-20 (SCL-20) was the primary outcome. Secondary outcomes included pain and health-related quality of life.
Pain was reported by more than two thirds of depressed patients at baseline, with the severity of pain mild in 25% of patients, moderate in 30%, and severe in 14%. After 3 months of antidepressant therapy, 24% of patients had a poor depression treatment response (ie, SCL-20 >1.3). Multivariate odds ratios for poor treatment response were 1.5 (95% confidence interval, 0.8-3.2) for mild pain, 2.0 (1.1-4.0) for moderate pain, and 4.1 (1.9-8.8) for severe pain compared with those without pain. Increasing pain severity also had an adverse impact on outcomes in multiple domains of health-related quality of life.
Pain is present in two thirds of depressed primary care patients begun on antidepressant therapy, and the severity of pain is a strong predictor of poor depression and health-related quality of life outcomes at 3 months. Better recognition, assessment, and treatment of comorbid pain may enhance outcomes of depression therapy.
疼痛常与抑郁症并存，但其对治疗结果的影响尚未得到充分研究。因此，我们前瞻性地评估了合并疼痛对抑郁症治疗反应及健康相关生活质量的影响。
我们分析了来自ARTIST研究的数据，这是一项在37家初级保健诊所进行的具有自然随访的随机对照试验。参与者为573名临床抑郁症患者，他们被随机分配至三种选择性5-羟色胺再摄取抑制剂（SSRI）抗抑郁药之一：氟西汀、帕罗西汀或舍曲林。通过症状清单-20（SCL-20）评估的抑郁症是主要结局。次要结局包括疼痛及健康相关生活质量。
超过三分之二的抑郁症患者在基线时报告有疼痛，其中25%的患者疼痛程度为轻度，30%为中度，14%为重度。抗抑郁治疗3个月后，24%的患者抑郁症治疗反应不佳（即SCL-20>1.3）。与无疼痛的患者相比，轻度疼痛患者治疗反应不佳的多变量优势比为1.5（95%置信区间，0.8 - 3.2），中度疼痛患者为2.0（1.1 - 4.0），重度疼痛患者为4.1（1.9 - 8.8）。疼痛严重程度增加也对健康相关生活质量的多个领域的结局产生不利影响。
在开始接受抗抑郁治疗的初级保健抑郁症患者中，三分之二存在疼痛，且疼痛严重程度是3个月时抑郁症及健康相关生活质量不佳结局的有力预测指标。更好地识别、评估和治疗合并疼痛可能会改善抑郁症治疗的结局。
